OG15.1 | Common Operative Obstetric Procedures — Summary & Reflection

KEY TAKEAWAYS

Operative obstetrics encompasses vacuum extraction, forceps delivery, caesarean section, assisted breech delivery, ECV, and cervical cerclage. Instrumental delivery (vacuum or forceps) requires: full dilatation, vertex (or face for certain forceps), engaged head, known position, empty bladder, adequate analgesia, and theatre backup. Vacuum cup must be placed on the flexion point (3 cm anterior to the posterior fontanelle); three pop-offs or 20 minutes = abandon. Forceps require precise position knowledge; blades are introduced in the transverse diameter. LSCS: transverse lower-segment uterine incision; Joel-Cohen or Pfannenstiel skin incision; key steps are bladder reflection, blunt uterine entry, and controlled head delivery. Assisted breech: hands off until the umbilicus; Lovset's for shoulders; Mauriceau-Smellie-Veit for the aftercoming head. ECV: offered from 36 weeks for breech; tocolysis + CTG; absolutely contraindicated with placenta praevia. McDonald cerclage: purse-string at internal os for cervical incompetence; remove at 36–37 weeks. The most dangerous vacuum complication is subgaleal haemorrhage (expands, crosses suture lines, causes shock). The most important stopping rule: abandon instrument and proceed to CS if no descent after 3 pulls or 20 minutes.

REFLECT

Reflect on the ethical and practical dimensions of consent in operative obstetrics. When you prepare a woman for vacuum extraction in the second stage, you have perhaps two minutes to explain the procedure, its risks, and the alternative of CS. How do you communicate the key information — especially the risk of neonatal scalp injury — without causing panic that prevents the woman from cooperating with the procedure? Now consider the system level: what training, simulation, and credentialling processes should exist in your future hospital to ensure that any clinician who picks up a pair of forceps has actually been trained to use them correctly? What is the role of the senior on-call obstetrician in supervising instrumental deliveries performed by junior staff?