Compared to the use of the vacuum extractor, forceps delivery is associated with increased risk of?

Appeared in: BHU NO - 2015

Explanation

Forceps delivery involves the application of rigid metal blades to the sides of the fetal head to assist with birth.
This direct pressure can compress the facial nerve (cranial nerve VII) against the facial bones, leading to a temporary or, rarely, permanent facial palsy.
The blades can also cause superficial injuries such as bruises, marks, or minor lacerations on the baby's face and scalp.

Option B: Cephalohematoma is a hallmark complication of vacuum extraction, not forceps delivery.
Option C: While retinal hemorrhages can occur, they are more commonly associated with vacuum extraction. Retinal detachment is a very rare complication of any delivery method.
Option D: This is a diagnostic procedure, not a complication of delivery.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Complications of Operative Vaginal Delivery as background academic context rather than a clinical decision trigger.
Nurses must perform a thorough head-to-toe assessment of any newborn delivered via operative vaginal delivery, paying close attention to the head and face.
Key nursing assessments include checking for facial symmetry at rest and while crying (to rule out facial nerve palsy), and inspecting the scalp for swelling, noting its characteristics (e.g., confined by suture lines for cephalohematoma).
What if? If a cephalohematoma is noted, the nurse should document the finding, reassure the parents that it is usually benign and self-resolving, and monitor the infant for developing jaundice, as the breakdown of collected blood can increase bilirubin levels.

How to Approach the Question

First, identify the core of the question. It asks to compare the risks of two specific procedures: forceps delivery and vacuum extraction.
The question specifically asks for a risk that is increased with forceps when compared to vacuum.
Consider the mechanism of each instrument. Forceps are rigid blades that apply pressure and traction. A vacuum extractor uses a suction cup to apply traction.
Evaluate each option based on these mechanisms. 'Minor facial injuries' are plausible from pressure applied by forceps blades to the face.
'Cephalohematoma' is a blood collection under the scalp, which is more plausibly caused by the suction of a vacuum cup.
Eliminate 'Fetal umbilical Doppler velocimetry' as it is a diagnostic test, not a complication of delivery.

Concept Tested & Keywords

QiVKMyjZ4egct50g9fmI9K

E6 Obstetrics Williams pp. 37-55, 18-35

Practise the full BHU NO - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.