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Chapter 14 - Instrumental Vaginal Delivery

from Section 3 - Intrapartum Emergencies

Published online by Cambridge University Press:  06 May 2021

Edwin Chandraharan
Affiliation:
St George's University of London
Sir Sabaratnam Arulkumaran
Affiliation:
St George's University of London
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Summary

Caesarean section rates are on the rise and this may be partly due to lack of appropriate training and experience in instrumental deliveries as well as medico-legal issues. Since caesarean section performed in the second stage of labour is associated with increased maternal morbidity, an appropriately performed instrumental vaginal delivery may help avoid the unnecessary risks.

Instrumental vaginal deliveries can be hazardous in inexperienced hands and should be undertaken with due care and supervision. Various intrapartum measures may help reduce the need for assisted vaginal delivery such as use of partogram, upright or lateral maternal position, one-to-one support to the woman in labour, delayed pushing in women having epidural anaesthesia or judicious use of oxytocin in the second stage of labour, especially in women with epidural anaesthesia.

Type
Chapter
Information
Obstetric and Intrapartum Emergencies
A Practical Guide to Management
, pp. 98 - 106
Publisher: Cambridge University Press
Print publication year: 2021

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References

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 17: Operative Vaginal Delivery. Washington, DC: ACOG, 2000.Google Scholar
Howell, C, Grady, K, Cox, C. Managing Obstetric Emergencies and Trauma: The MOET Course Manual, 2nd ed. London: RCOG, 2007.Google Scholar
Baskett, TF, Calder, AA, Arulkumaran, S. Assisted vaginal delivery. In Munro Kerr’s Operative Obstetrics, 11th ed. Edinburgh: Elsevier; 2007, 91125.Google Scholar
Chandraharan, E, Arulkumaran, S. Operative delivery, shoulder dystocia and episiotomy. In Arulkumaran, S, Penna, LK, Bhasker Rao, K (eds), The Management of Labour, 2nd ed. Orient Longman (India); 2006, 137–62.Google Scholar
Ramphul, M, Ooi, PV, Burke, G, Kennelly, MM, Said, SAT, Montgomery, AA, et al. Instrumental delivery and ultrasound: a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BJOG. 2014;121:1029–38.CrossRefGoogle Scholar
Baskett, TF, Arulkumaran, S (eds). Assisted vaginal delivery. In Intrapartum Care for the MRCOG and Beyond. London: RCOG; 2002, 6374.Google Scholar
Ameh, C, Weeks, A. The role of instrumental vaginal delivery in low resource settings. Br J Obstet Gynaecol. 2009;116(Suppl. 1):22–5.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians and Gynaecologists. Operative Vaginal Delivery. Green-top Guideline No. 26. London: RCOG; 2011.Google Scholar

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