Operative Obstetrics

Overview – Operative Obstetrics

Operative obstetrics refers to the use of surgical or instrument-assisted techniques to safely deliver a baby when spontaneous vaginal birth is not progressing or is contraindicated. Operative obstetrics includes forceps and vacuum-assisted vaginal deliveries, as well as caesarean sections. These interventions are essential in managing maternal or fetal complications and are commonly encountered in both clinical placements and OSCEs.

Definition

Operative obstetrics encompasses any intervention that aids delivery by surgical or mechanical means. This includes:

• Operative vaginal delivery using forceps or vacuum (ventouse)
• Caesarean delivery via abdominal and uterine incisions
• Episiotomy to enlarge the vaginal opening when needed

Aetiology

Fetal Indications

• Non-reassuring or atypical fetal heart rate patterns
• Suspected fetal compromise
• Prolonged second stage of labour

Maternal Indications

• Contraindications to active maternal effort (e.g. cerebrovascular disease, ischaemic heart disease, cerebral aneurysms)
• Maternal exhaustion or excessive sedation

Contraindications

(Primarily related to operative vaginal delivery)

• Non-vertex presentations (e.g. brow or face)
• Unengaged fetal head
• Incomplete cervical dilation

Operative Vaginal Delivery

Forceps

Advantages:

• Higher rate of successful delivery
• Lower fetal morbidity

Disadvantages:

• Increased risk of maternal soft tissue injury

Vacuum (Ventouse)

Advantages:

• Easier to apply
• Requires less anaesthesia
• Lower maternal trauma

Disadvantages:

• Not usable in preterm deliveries
• Requires maternal pushing effort

Episiotomy

Definition

• A surgical incision made in the perineum during delivery to widen the vaginal opening.

Indications

• To relieve perineal soft tissue obstruction
• To expedite delivery, particularly in cases of fetal distress

Complications

• Perineal infection
• Haematoma
• Rectovaginal fistula
• Anal or urinary incontinence

Caesarean Delivery

Definition

• Surgical delivery of a baby through incisions in the abdominal wall and uterus
• Accounts for approximately 20–25% of deliveries

Indications

• Maternal pelvic obstruction
• Active genital herpes infection
• Invasive cervical cancer
• Previous uterine surgery (e.g. prior caesarean)
• Eclampsia or HELLP syndrome
• Failure to progress in labour
• Placental abruption or previa
• Vasa previa
• Malpresentation (e.g. breech, transverse lie)
• Umbilical cord prolapse

Complications

• Anaesthetic risks
• Haemorrhage
• Infection (e.g. endometritis — prophylactic antibiotics are recommended)
• Injury to adjacent structures (e.g. bladder, bowel)
• Venous thromboembolism (e.g. deep vein thrombosis or pulmonary embolism)
• Longer maternal recovery time

Summary – Operative Obstetrics

Operative obstetrics includes essential techniques such as operative vaginal delivery, episiotomy, and caesarean section. These interventions are employed when maternal or fetal factors prevent safe spontaneous delivery. A strong understanding of their indications, contraindications, and complications is crucial for clinical practice. For a broader context, see our Obstetrics Overview page.