Trial of Forceps/Operative Vaginal Delivery

Operative delivery is:

• Indicated for:
  • Foetal compromise
  • Maternal effort contraindicated
  • Need to expedite second stage
• Performed with forceps or ventouse
• Not always performed in theatre
  Need for OT generally reflects liklihood of failure and requirement to convert to caesarian section
  
  • Caesarian following attempted instrumental delivery is complex
    Associated with ↑ morbidity:
    • Maternal
      • Major PPH
      • Transfusion
      • Cystotomy
      • Hysterectomy
      • ICU admission
    • Foetal
      • Neonatal acidosis
      • ICH
      • Requirement for resuscitation
• Analgesia requirements vary
  Anaesthesia usually only involved in OT.
  • Pudendal nerve block
  • Field block
  • Neuraxial (including labour epidural)
    May be required for mid-rotational positions.

Induction

If being performed in theatre, it is safer to assume the forceps will fail (although ~2/3^rds are successful) and caesarian will be performed:

• Spinal
  Consider omitting long-acting intrathecal opioid - discuss with obstetrician liklihood of successful forceps delivery.
• Epidural top-up
  Give standard dose top-up.

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References

1. Nikpoor P, Bain E. Analgesia for forceps delivery. Cochrane Database Syst Rev. 2013 Sep 30;9:CD008878.
2. RANZCOG. Instrumental Vaginal Birth. RANZCOG. 2016.
3. King Edward Memoral Hospital Guideline. Operative Birth. Government of Western Australia North Metropolital Health Service; Women and Newborn Health Service.
4. Stock, O. Obstetrics for the Anaesthetist. RWH Anaesthetic Tutorial Program.