Ventouse Delivery

Ventouse Delivery

Q. 1

All of the following statements are true regarding comparison between vacuum delivery and forceps delivery, EXCEPT:

 A

Retinal hemorrhage, intracranial hemorrhage and subgaleal hemorrhage are more common in ventouse delivery than forceps

 B

Intracranial pressure rises during traction

 C

Cephalohematoma is more common with vacuum extraction

 D

Less maternal trauma by vacuum as compared with forceps

Q. 1

All of the following statements are true regarding comparison between vacuum delivery and forceps delivery, EXCEPT:

 A

Retinal hemorrhage, intracranial hemorrhage and subgaleal hemorrhage are more common in ventouse delivery than forceps

 B

Intracranial pressure rises during traction

 C

Cephalohematoma is more common with vacuum extraction

 D

Less maternal trauma by vacuum as compared with forceps

Ans. B

Explanation:

Advantages of the vacuum extractor compared with forceps include: 

  • Avoidance of insertion of space-occupying steel blades within the vagina
  • No requirement for precise positioning over the fetal head
  • Less maternal trauma
  • Less intracranial pressure during traction
Complications of the vacuum extractor include,
  • Scalp lacerations and bruising
  • Subgaleal hematomas
  • Cephalohematomas
  • Intracranial hemorrhage
  • Neonatal jaundice
  • Subconjunctival hemorrhage
  • Clavicular fracture
  • Shoulder dystocia
  • Injury of sixth and seventh cranial nerves
  • Erb palsy
  • Retinal hemorrhage
  • Fetal death
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 23. Forceps Delivery and Vacuum Extraction. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Q. 2

All of the following are contraindications of ventouse extraction, EXCEPT:

 A

Foetal macrosomia

 B

Face presentation

 C

Transverse lie

 D

Anemia

Q. 2

All of the following are contraindications of ventouse extraction, EXCEPT:

 A

Foetal macrosomia

 B

Face presentation

 C

Transverse lie

 D

Anemia

Ans. D

Explanation:

Contraindications for ventouse delivery:

  • Any presentation other than vertex (face, brow, breech)
  • Preterm fetus (
  • Suspected fetal coagulation disorder
  • Suspected fetal macrosomia (>4 kg)

Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 580.


Q. 3

All are treatment of deep transverse arrest except :

 A

Ventouse

 B

Cesarean section

 C

Manual rotation with outlet forceps

 D

Craniotomy

Q. 3

All are treatment of deep transverse arrest except :

 A

Ventouse

 B

Cesarean section

 C

Manual rotation with outlet forceps

 D

Craniotomy

Ans. C

Explanation:

Manual rotation with outlet forceps


Q. 4

In deep transverse arrest with adequate pelvis, best mode of delivery will be :

 A

Ventouse

 B

Keilland forceps

 C

Manual rotation followed by forceps

 D

Cesarean section

Q. 4

In deep transverse arrest with adequate pelvis, best mode of delivery will be :

 A

Ventouse

 B

Keilland forceps

 C

Manual rotation followed by forceps

 D

Cesarean section

Ans. A

Explanation:

Ventouse


Q. 5

 

A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal ex­amination reveals a fundal height of 36 weeks, cephalic presentation, foetal heart absent, mild uterine contractions present. On PN examina­tion, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Dirty, infected discharge is present. What would be the best management option after initial work-up ?

 

 A

Cesarean section

 B

Oxytocin drip

 C

Ventouse delivery

 D

Craniotomy and vaginal delivery

Q. 5

 

A primigravida with full term pregnancy in labor for 1 day is brought to casualty after dia handing. On examination she is dehydrated, slightly pale, bulse 100/min, BP120 / 80 mm Hg. abdominal ex­amination reveals a fundal height of 36 weeks, cephalic presentation, foetal heart absent, mild uterine contractions present. On PN examina­tion, cervix is fully dialted, head is at +1 station, caput with moulding present, pelvis adequate. Dirty, infected discharge is present. What would be the best management option after initial work-up ?

 

 A

Cesarean section

 B

Oxytocin drip

 C

Ventouse delivery

 D

Craniotomy and vaginal delivery

Ans. C

Explanation:

Ventouse delivery


Q. 6

Ventouse extraction is done in all except :

 A

Deep transverse arrest

 B

Atter-coming head of breech

 C

Delay in first stage due to uterine inertia

 D

Delay in descent of high head in case of second baby of twins

Q. 6

Ventouse extraction is done in all except :

 A

Deep transverse arrest

 B

Atter-coming head of breech

 C

Delay in first stage due to uterine inertia

 D

Delay in descent of high head in case of second baby of twins

Ans. B

Explanation:

Atter-coming head of breech


Q. 7

Ventouse application, the prerequisite is :

 A

Full dilatation of cervix

 B

Station +2

 C

Premature

 D

Head engaged

Q. 7

Ventouse application, the prerequisite is :

 A

Full dilatation of cervix

 B

Station +2

 C

Premature

 D

Head engaged

Ans. D

Explanation:

Head engaged


Q. 8

Contraindications to ventouse delivery include all of the following except :

 A

Fetal coagulopathies

 B

Extreme prematurity

 C

Mento transverse position

 D

Occipito transverse position

Q. 8

Contraindications to ventouse delivery include all of the following except :

 A

Fetal coagulopathies

 B

Extreme prematurity

 C

Mento transverse position

 D

Occipito transverse position

Ans. D

Explanation:

Occipito transverse position


Q. 9

During application of the cup in Ventouse, ‘knob’ of the cup points towards:       

March 2013

 A

Brow

 B

Chin

 C

Neck

 D

Occiput

Q. 9

During application of the cup in Ventouse, ‘knob’ of the cup points towards:       

March 2013

 A

Brow

 B

Chin

 C

Neck

 D

Occiput

Ans. D

Explanation:

Ans. D i.e. Occiput

Ventouse Indications

  • As an alternative to forceps operation.
  • Deep transverse arrest with adequate pelvis
  • Delay in descent of head of the second baby of twins
  • Delay in first stage due to uterine inertia or primary cervical dystocia

Contraindications

  • Prematurity
  • Head not engaged
  • Fetal distress
  • Pelvic contraction
  • Transverse lie
  • After coming head of breech
  • Partially dilated cervix
  • Congenital anomalies
  • Dead fetus.

Complications

  • Cephalhematoma
  • Subaponeurotic or subgaleal haemorrhage
  • Chignon
  • Retinal hemorrhage

Q. 10

Pressure in ventouse assisted delivery is:

September 2006

 A

0.4 kg/sq.cm

 B

0.6 kg/sq.cm

 C

0.8 kg/sq.cm

 D

1.0 kg/ sq.cm

Q. 10

Pressure in ventouse assisted delivery is:

September 2006

 A

0.4 kg/sq.cm

 B

0.6 kg/sq.cm

 C

0.8 kg/sq.cm

 D

1.0 kg/ sq.cm

Ans. C

Explanation:

Ans. C: 0.8 kg/sq.cm

A. Indications

  1. Suspicion of fetal compromise (e.g. nonreassurirtg Fetal Heart Tones)
  2. Maternal exhaustion
  3. Prolonged second stage of labor

The pressure is gradually raised at the rate of 0.1 kg/sq.cm per minute until the effective vacuum of 0.8 kg/sq.cm is achieved in about 10 minutes time.

B. Contraindications

  1. Cephalopelvic Disproportion
  2. Fetal head not engaged
  3. Gestational age earlier than 34 weeks
  4. Known fetal disorders predisposing to complication -Bone mineralization disorders, Bleeding Disorder
  5. Malpresentation-Noncephalic presentation, Face Presentation (Occipitoposterior presentation is not a contraindication to vacuum Assisted Delivery)

C. Precautions

  1. Vacuum can do as much or more damage as forceps

D. Criteria to discontinue (prevent Subgaleal Hemorrhage):

  1. No progress after 3 pulls
  2. No baby extraction in 30 minutes after initiation
  3. Cup disengages 3 times
  4. Significant fetal scalp or maternal trauma


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