June 09, 2023

Operative Vaginal Deliveries

14 minutes

Operative vaginal delivery with forceps or vacuum is uncommon but high-stakes. This episode covers the current incidence, indications, consent considerations, preparation checklist, and contraindications – including what to say about forceps vs. vacuum success rates and laceration risk.

Show Outline:

Incidence – 3.3% as of 2013

Indications – Prolonged second stage, risk of fetal compromise, shortening 2nd stage for maternal benefit (e.g., cardiac conditions)

Consent – Comparison is typically c-section. Failure rate of OVD is ~3–6%. Forceps has a higher success rate over vacuum but also higher risk of 3rd/4th degree laceration. Risks to both mom and baby.

Preparation

Fetus at appropriate station/position

Anesthesia

Empty bladder

Assess pelvis/passenger sizes/fit

OR ready

Pediatrics available

Episiotomy – NO! (Not routinely indicated.)

Contraindications – Fetal conditions, known or suspected: bone disorders (OI), bleeding disorders. Maternal infections: Hep C, HIV, etc. Concern for shoulder dystocia or cephalopelvic disproportion.

About the Speaker:

Jennifer Doorey, MD, MS – Academic Ob/Gyn at The Johns Hopkins University School of Medicine. As the founder of MedReady, Dr. Doorey seeks to advance clinical medical education by developing resources for medical students and clinical educators.

Procedure Ready: Ob/Gyn is a podcast aimed at medical, PA, and NP students entering their clinical rotation in Ob/Gyn. The views expressed are the speaker's own and do not constitute medical advice.

...more