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Operative Vaginal Delivery Indications

Operative Vaginal Delivery (forceps/vacuum): Indications Authors: Taylor Pigott Akaya Blair Reviewers: Michelle J. Chen Sylvie Bowden* Stephanie Cooper* Sarah Glaze* * MD at time of publication Abnormal fetal heart rate/fetal distress ↓ Risk of maternal and fetal morbidity/ morality Rupture of membranes without fetal head adequately applied to maternal pelvis Small pelvic outlet Narrow vaginal canal Cardiovascular disease Diabetes Hypertension Abdominal trauma Short umbilical cord Large for gestational age (LGA) fetus Neurological/ muscular disease ↑ Pain during labor Maternal contraindication to Valsalva maneuver (e.g., cardiac disease, cystic lung) Rush of fluid past the fetal head out through cervix Umbilical cord prolapse Umbilical vasoconstriction Umbilical cord compression ↓ Blood flow through umbilical cord Fetal presenting part applies pressure on umbilical cord Impaired vascular function and narrowed vessels ↓ blood flow around the body ↓ Oxygen transfer across the placenta Fetal oxygen deprivation and hypoxia Operative vaginal delivery with forceps or vacuum expedites delivery Placenta partially or completely separates from uterine wall (abruption) Increased tension of umbilical cord on placenta Fetal shoulder is lodged behind maternal pubic symphysis Delivery of the body is delayed Inability to adequately bear down to push Myometrium runs out of energy from repeated contractions and becomes less able to contract (↓ uterine tone) Uterine spiral arteries dependent on contractions for vasoconstriction remain dilated, allowing blood flow Postpartum hemorrhage Uterine rupture ↑ Risk of future pelvic organ prolapse ↑ Risk of future incontinence Prolonged labour Repeated contraction/ relaxation of the uterus without progress tears and damages uterine muscles ↓ Maternal endurance Inadequate fluid and food intake prior to/ during labor Multiples ↑ Sympathetic nervous system activation during labor Maternal exhaustion Uterine muscles stretch to accommodate multiple growing fetuses ↑ Pushing against pelvic floor and perineum Pushing force damages pelvic floor muscles and nerves ↓ Myometrial contractility ↑ Need for vaginal exams to check on labour progress Bacterial overgrowth in vagina and/or uterus Maternal infection Fetal infection ↓ Strength of contractions Epidural anesthetic Inability to ambulate to urinate ↑ Urinary catheterizations ↑ Epinephrine secretion from adrenal cortex Blood is shunted away from uterus/internal organs and towards heart and skeletal muscle Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published 03, ##, 2023 on www.thecalgaryguide.com