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Assisted vaginal delivery

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of assisted vaginal delivery are prepared by our editorial team based on guidelines from the European Association of Perinatal Medicine (EAPM 2022), the World Health Organization (WHO 2021), the American College of Obstetricians and Gynecologists (ACOG 2020), the Royal College of Obstetricians and Gynaecologists (RCOG 2020), and the Society of Obstetricians ...
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Classification and risk stratification

Classification: as per RCOG 2020 guidelines, use a standard classification system for assisted vaginal delivery to promote safe clinical practice, effective communication between health professionals, and audit of outcomes.
B
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Diagnostic investigations

Ultrasound
As per RCOG 2020 guidelines:
Obtain ultrasound assessment of the fetal head position before assisted vaginal delivery where uncertainty exists following clinical examination.
A
Insufficient evidence to recommend routine abdominal or perineal ultrasound for assessment of the station, flexion, and descent of the fetal head in the second stage of labor.
I

Medical management

Antibiotic prophylaxis: as per WHO 2021 guidelines, administer routine antibiotic prophylaxis in females undergoing operative vaginal birth.
A

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Nonpharmacologic interventions

Psychological support: as per RCOG 2020 guidelines, ensure shared decision-making and good communication, and provide positive continuous support during labor and birth to reduce psychological morbidity after birth.
E
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Therapeutic procedures

Indications for assisted vaginal delivery: as per RCOG 2020 guidelines, recognize that no indication is absolute and clinical judgment is required in all situations.
B

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  • Contraindications to assisted vaginal delivery

  • Choice of instrument

  • Considerations for assisted vaginal delivery (general principles)

  • Considerations for assisted vaginal delivery (vacuum extraction)

  • Considerations for assisted vaginal delivery (forceps use)

Surgical interventions

Episiotomy: as per EAPM 2022 guidelines, perform episiotomy by indication only,
B
including in order to shorten the second stage of labor when there is suspected fetal hypoxia,
B
, prevent obstetric anal sphincter injury in vaginal operative deliveries, or when obstetric sphincter injury occurred in previous deliveries.
B
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Patient education

Antenatal counseling: as per RCOG 2020 guidelines, inform patients about assisted vaginal delivery in the antenatal period, especially during their first pregnancy, and if they indicate specific restrictions or preferences then explore this with an experienced obstetrician, ideally in advance of labor.
E
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More topics in this section

  • Postpartum counseling

Preventative measures

Prevention of assisted vaginal delivery: as per RCOG 2020 guidelines, ensure continuous support during labor to reduce the need for assisted vaginal birth.
A
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Follow-up and surveillance

Prevention of urinary retention: as per RCOG 2020 guidelines, counsel patients about the risk of urinary retention ensuring that they are aware of the importance of bladder emptying in the postpartum period.
E
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Quality improvement

Documentation: as per RCOG 2020 guidelines, document the following regarding assisted vaginal delivery using a standardized form:
detailed information on the assessment
decision making and conduct of the procedure
a plan for postnatal care
sufficient information for counseling in relation to subsequent pregnancies.
E
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More topics in this section

  • Health professional training