Operative vaginal delivery refers to any operative procedure designed to expedite vaginal delivery.
The choice depends largely on obstetrician’s preference and expertise.
- It is a surgical incision made in the perineum to facilitate the delivery.
- It reduces the pelvic floor trauma , bleeding , infections and genital prolapse.
Types of episiotomy
- It extends from the posterior vaginal forchette towards rectum in the midline.
- Disadvantages are that it may involve external anal sphincter.
- It extends 45 degree to the posterior forchette on right or left side.
- Mediolateral episiotomy on the right side is the most common type of episiotomy given.
Stitching of episiotomy
- Vagina with continuous non locking sutures using chromic catgut 1 or 0 or vicryl , vicryl rapide can also be used, depending upon the choice of the surgeon.Be sure that you have caught the apex of the cut vaginal wound.
- Muscle is stitched with interrupted sutures
- Skin with mattress sutures.
- Maternal exhaustion
- Prolonged second stage of labour
- Need to avoid expulsive forces as in cardiovascular diseases or spinal cord injuries.
- fetal distress
- They were introduced by chamberlain family in 18 th century.
Types of forceps are
Criteria to be fulfilled for forceps application
- Adequate analgesia
- Written consent
- Bladder should be empty
- Adequate pelvimetry should be done
- Vertex presentation
- Head should be engaged.
- Position , station of the head , amount of the caput should be assessed.
- Cervix should be fully dilated.
- No placenta previa should be there.
- Cesarean section preparation should be kept ready.
- fetal macrosomia
- Suspected fetal coagulation disorders.
- Increased perineal injury
- fetal brusing
- facial nerve palsy
Application of ventouse
- Failed delivery with very soft cup.
- Scalp lacerations
- Maternal perineal injuries are less with vacuum.