📘 ASSISTED DELIVERIES

(Highly Important for GNM, BSc Nursing, Midwifery, NHM, AIIMS, NORCET, GPSC & Staff Nurse Exams)

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✅ 1. Introduction / Definition

Assisted delivery (also called instrumental vaginal delivery) refers to vaginal birth aided with special instruments when the mother is unable to push effectively, or if there’s fetal or maternal distress. The goal is to ensure a safe and timely delivery.

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✅ 2. Indications for Assisted Delivery

Maternal Indications	Fetal Indications
Prolonged second stage of labor	Non-reassuring fetal heart rate
Maternal exhaustion	Fetal distress (hypoxia)
Cardiac/pulmonary disease in mother	After-coming head in breech delivery
Neurological conditions	Premature baby requiring quick birth

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✅ 3. Types of Assisted Vaginal Deliveries

🔹 1. Forceps Delivery

• Instrument: Metal tongs with two blades
• Use: Applies traction to fetal head
• Types:
  • Outlet forceps (fetal head visible)
  • Low forceps (fetal head at +2 station)
• Indications: Maternal fatigue, fetal distress
• Complications:
  • Maternal: Vaginal/perineal tears
  • Fetal: Facial nerve injury, scalp laceration

🔹 2. Vacuum Extraction (Ventouse)

• Instrument: Suction cup applied to fetal scalp
• Use: Traction is applied with contractions
• Indications: Similar to forceps but preferred in cases with minimal fetal rotation
• Contraindication: Premature babies (<34 weeks)
• Complications:
  • Maternal: Genital tract trauma
  • Fetal: Cephalohematoma, scalp edema (chignon)

🔹 3. Breech Extraction

• Used in breech presentations when the baby’s legs or buttocks come first, and assistance is needed for the head
• Often requires Mauriceau-Smellie-Veit maneuver

🔹 4. Manual Assistance (e.g., Controlled Cord Traction)

• In active management of third stage of labor
• Helps in placental delivery

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✅ 4. Prerequisites Before Performing Assisted Delivery

• Full cervical dilation
• Ruptured membranes
• Fetal head engaged
• Accurate knowledge of fetal position
• Empty maternal bladder
• No cephalopelvic disproportion

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✅ 5. Nursing Responsibilities

• Prepare and sterilize instruments
• Explain the procedure and provide psychological support
• Monitor vital signs, uterine contractions, and fetal heart rate
• Position the mother appropriately (usually lithotomy)
• Assist obstetrician during the procedure
• Document all events and maintain asepsis
• Monitor for complications post-delivery (PPH, neonatal injury)

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✅ 6. Complications of Assisted Deliveries

🔸 Maternal:

• Vaginal/cervical/perineal tears
• Postpartum hemorrhage
• Infections

🔸 Neonatal:

• Facial or scalp injury
• Cephalohematoma
• Intracranial hemorrhage (rare)

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✅ 7. Golden One-Liners for Quick Revision

• Forceps delivery is contraindicated in unengaged head
• Vacuum extraction is not used in preterm (<34 weeks)
• Ventouse may cause cephalohematoma or chignon
• Full dilation and ruptured membranes are prerequisites
• Breech delivery often needs Mauriceau-Smellie-Veit maneuver

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✅ 8. Top 5 MCQs for Practice

1. Which of the following is a contraindication for vacuum-assisted delivery?
a) Full-term pregnancy
b) Fetal distress
c) Preterm fetus (<34 weeks)
d) Maternal fatigue
Correct Answer: c) Preterm fetus (<34 weeks)
Rationale: Preterm scalp is fragile; vacuum can cause severe injury.

2. Which maneuver is used during breech extraction to deliver the after-coming head?
a) Ritgen’s maneuver
b) McRobert’s maneuver
c) Mauriceau-Smellie-Veit maneuver
d) Bracht’s maneuver
Correct Answer: c) Mauriceau-Smellie-Veit maneuver
Rationale: This maneuver supports and flexes the fetal head for safe extraction.

3. Chignon is a side effect of which type of assisted delivery?
a) Cesarean section
b) Vacuum extraction
c) Forceps delivery
d) Manual rotation
Correct Answer: b) Vacuum extraction
Rationale: Chignon is a temporary swelling from suction cup application.

4. What is the primary nursing responsibility before assisted delivery?
a) Administer antibiotics
b) Fill the bladder
c) Explain the procedure and ensure bladder is empty
d) Start breastfeeding
Correct Answer: c) Explain the procedure and ensure bladder is empty
Rationale: Full bladder may obstruct fetal descent or risk bladder injury.

5. Which instrument is used to apply traction directly to the fetal head?
a) Ventouse
b) Forceps
c) Amniotic hook
d) Bladder catheter
Correct Answer: b) Forceps
Rationale: Forceps apply direct traction to deliver the fetal head.