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Instrumental vaginal delivery 

Instrumental vaginal delivery
Instrumental vaginal delivery

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

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date: 28 October 2020

Both a valid indication and the necessary conditions must be met before instrumental delivery is undertaken. The cervix must be fully dilated; effective analgesia must be in place; and the operator must be familiar with the chosen instrument. There is no justification for a ‘difficult instrumental delivery’. Cesarean section would almost always be preferable. Shortening of the second stage with elective instrumental delivery can result in a clinically unimportant gain in umbilical cord blood pH, but may lead to a considerable increase in maternal vaginal and perineal trauma. Forceps delivery and vacuum extraction are to a large extent interchangeable procedures. The available evidence indicates that the use of forceps is more likely to result in maternal injury, and is more dependent on extensive analgesia or anesthesia than is vacuum extraction.

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