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Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.
This chapter discusses instrument design, technique of application, and the risks and benefits of assisted delivery. The principal controversies concerning instrumental delivery by both forceps and the vacuum extractor are reviewed, and recommendations are made about the use of these instruments. The focus of this presentation remains the desirability and safety of instrumental delivery and a critical analysis of what constitute the best modern practice. Delivery instruments are conveniently classified into eight types: five of forceps, two of vacuum extractors, and one for miscellaneous instruments. The most important contraindications to vaginal delivery operations are operator inexperience and the inability to achieve a proper application. Educating clinicians in the appropriate use of force in instrumental deliveries is a difficult task. Instrument application involves forceps operation, and vacuum extraction. Maternal perineal lacerations are common complications of all operative vaginal deliveries; most are associated with episiotomy.
Over many years, various manipulations and specialized instruments were developed to expedite delivery of viable infants or to remove the fetus and the other products of conception from the uterus in case of fetal demise or incomplete delivery. A brief historical review of the origins of operative delivery techniques increases the appreciation of modern practitioners for the complex roots of the science and art that have led to modern practice. From the inception of the operation, controversy concerning the propriety of cesarean delivery has characterized the medical literature. It was recognized very early that postmortem operations on mothers dying in labor or late in pregnancy would rarely result in a normal and surviving child. The development of atraumatic delivery instruments is a complex and fascinating part of the history of obstetrics. An important development in the use of vacuum extraction has been major improvements in practitioner education.
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