True about instrumental vaginal delivery:
Correct Answer: Forceps are used in all cases of breech delivery
Description: Ans. is b, i.e. Forceps are used in all cases of breech deliveryRef. Dutta Obs. 9/e, p 533; COGDT 10/e. p 468Conditions (Criteria) to be fulfilled prior to forceps operationFetal and uteroplacental criteriaMaternal criteria* The fetal head must be engaged* The cervix must be fully dilated* The membranes must be ruptured* The position and station of the fetal head must be known with certainty* No major cephalopelvic disproportion by clinical pelvimetry* Bladder must be emptied* Adequate analgesiaThus, fully dilated cervix is not the only prerequisite (Option "a" is incorrect).Option "b" i.e. Forceps are used in all cases of breech deliveryThe most commonly used method in breech presentation is the assisted breech delivery where Burns Marshall technique is used for the aftercoming head which does not involve the use of forceps but,Dutta 9/e, p 360 says "Forceps can be used as a routine".Sheila Balakrishnan p 454 says "Forceps for the aftercoming head, Piper's forceps or any straight forceps can be used. This is the best method of delivery of the head."COGDT 10/e, p 347 says "Piper forceps may be used electively or when the Mauriceau-Smellie-Veit maneuver fails to deliver the aftercoming head".So, forceps can be used routinely in breech deliveries but it is not a common practice. So, option 'b' can be kept in +/- status.Earlier we have studied that ventouse is used in unrotated/malrotated occipitotransverse/posterior deliveries (option 'd' incorrect).As far as option 'c' is concerned, i.e. Forceps may be used if ventouse fails.COGDT 10/e, p 468 says "Under no circumstances should the operator switch from vacuum to forceps or vice versa. An excellent study examining neonatal injury clearly demonstrated that the greatest incidence of neonatal injury occurred in babies in whom both vacuum and forceps were used."So, amongst all the options given, option 'b' is partially correct. We are taking it as the answer of choice here.
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Gynaecology & Obstetrics
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