Operative delivery

Operative delivery
1- Instrumental delivery
Incidence: 6-12%

Indication:
1- Delay in 2nd stage of labor
2- Poor maternal effort
3- Fetal distress, cord prolapse in 2nd stage of labor.
4- Maternal indication: sever cardiac, respiratory, hypertension disease or intracranial pathology that bearing down effort my lead to death.
Causes of prolonged second stage of labor:-
1- Inadequate uterine contraction
2- Poor expulsive effort by the mother.
3- Minor disproportion or malposition.
4- Uses of epidural analgesia ? inadequate uterine contraction secondary to abolition of Ferguson s reflex (stretching of lower vagina by presenting part ? lead to release of oxytocin).

How to approach patient necessitate instrumental delivery?
1- Medical person should introduce himself to the patient.
2- Explain the indication, complication & contraindication of the procedure.
3- Verbal or written consent should be taken from the mother & partner.
4- Prerequisite criteria need to be full filled.
5- General examination of the mother, pain relief & hydration.
6- Analgesia in form of pudendal block & local perineal infiltration with 20 ml of 1% lignocaine & sometime spinal anesthesia is used in ( midcavity forceps)
7- Fetal condition should be assessed either clinically or by CTG