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    Dennen's Forceps Deliveries, Fourth Edition
    Dennen's Forceps Deliveries, Fourth Edition
    Dennen's Forceps Deliveries, Fourth Edition
    Ebook193 pages1 hour

    Dennen's Forceps Deliveries, Fourth Edition

    By American College of Obstetricians and Gynecologists

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    ACOG has revived a classic with the fourth edition of Dennen's Forceps Deliveries. This volume retains much of the original text, including explanations of forceps devices and technique. It also provides the latest related ACOG guidelines, a chapter on vacuum assisted deliveries, and information on the current and changing status of forceps deliveries
    LanguageEnglish
    PublisherACOG
    Release dateApr 3, 2023
    ISBN9781948258067
    Dennen's Forceps Deliveries, Fourth Edition

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      Dennen's Forceps Deliveries, Fourth Edition - American College of Obstetricians and Gynecologists

      Preface

      For many obstetricians trained in the 1930s through the 1960s, the use of forceps was an integral and important part of day-to-day practice. The variety of types of forceps and their indications were a critical part of the education of an obstetrician. This book was first published in 1947 by Dr. Edward Dennen to be used as a guide in this educational process. Other editions followed in 1955, 1965, and 1989. The last edition was edited by Dr. Philip Dennen, son of Dr. Edward Dennen. Since the time that the earlier editions were published and that I, like many of my contemporaries, learned the art and skill of forceps delivery, the care of the obstetric patient has evolved. No longer are forceps in common use in the labor and delivery areas of hospitals. Cesarean delivery now occurs at a rate of 20–25% and has replaced the use of forceps in many situations.

      Nevertheless, the use of forceps and an understanding of that use still are critical components of obstetric practice. When the American College of Obstetricians and Gynecologists (ACOG) learned that the publisher of this book had determined that there was insufficient demand to justify a revision or republishing of this text, an offer was made to buy the rights for the book. This edition is a result of the successful completion of that effort and of the College’s commitment to supply a time-proven resource for the use of forceps.

      This edition has been significantly revised to reflect the current status of forceps deliveries and to incorporate the changes taking place as we enter a new century. Previous discussions of special types of forceps have been relegated to the section on history, and a new chapter has been added on vacuum assisted delivery, which includes evidence-based recommendations regarding its use. Wherever possible, the original language and explanations by the original author have been maintained to preserve the classic nature of the book.

      This new edition was made available through ACOG’s Development Committee, whose funds are provided by College members to assist in projects outside regular College activities. As such, it can be truthfully stated that the effort to continue the availability of Dr. Dennen’s book, Forceps Deliveries, is one made on the part of obstetrician–gynecologists.

      Ralph W. Hale, MD, FACOG

      ACOG Executive Vice President

      Preface to the Third Edition

      Forceps Deliveries had its origin in the Manual of Forceps Deliveries, privately published by Dr. Edward H. Dennen in 1947. The Manual was used by his residents and his students at the Cornell Medical College and the New York Polyclinic Postgraduate Medical School. The book, completed with illustrations, evolved and was published by F.A. Davis in 1955. A second edition of Forceps Deliveries followed in 1965. It has now been out of print for many years. Numerous requests for copies have been received from practicing physicians, residents, and program directors. I have been told that a few copies that did not disappear from hospital libraries are protected and (as in my hospital) copied by individuals for their use.

      Although the obstetric goals of a healthy mother and infant are unchanged since 1965, the means to that end have become radically altered. The day of the 4% cesarean delivery rate is long gone, but so also is the day of the 50 per 1,000 neonatal mortality rate. Technology, medicine in general, and society in particular have induced changes in obstetric thinking and practice. Too frequently, operators with forceps ability are made aware, following a successful delivery, that in other institutions or in other hands a damaged infant could only have been avoided by abdominal delivery. This is the reason for this book.

      Many parts of the book are virtually unchanged from the original version, and credit belongs to the senior Dr. Dennen. In particular, descriptions of technique have stood the tests of time and also the specific efforts of an inquisitive son who, in over 30 years of active clinical practice and teaching, was unable to find a better way to perform or describe them. Material considered obsolescent or in conflict with modern obstetrics has been deleted. The 1988 American College of Obstetricians and Gynecologists forceps classification is used as reference. Alterations and additions to the book reflect current obstetric literature and are an effort to make Forceps Deliveries pertinent and useful to both student and clinician.

      Philip C. Dennen, MD, FACOG

      Note: This preface appeared in the third edition. Because it gives a unique insight into the original author and subsequent author, the Editor believes it should be included in this edition as well.

      Dennen’s Forceps Deliveries

      Fourth Edition

      CHAPTER 1

      Historic Review

      The history of the obstetric forceps is long and often colorful. Evidence of single or paired instruments in Sanskrit writings dates from about 1500 bc. Egyptian, Greek, Roman, and Arabic writings picture or refer to forceps, although it is presumed that most of these instruments were used for the extraction of a dead fetus. Credit for the invention of the precursor of the modern instruments for use on live infants goes to Peter Chamberlin (ca. 1600) of England. Gene Palfyn (1649–1730) of Ghent independently invented a paired mains de fer. William Smellie, in 1745, described the accurate application of forceps and rotation of the fetus to occiput anterior presentation, rather than the previously practiced pelvic application with traction regardless of the position of the head. The addition of a pelvic curve to the forceps is ascribed to Smellie and independently to André Levret (1747), who also developed the French lock. Etienne Tamier (1877) initiated the concept of axis traction with a new instrument. Inventions, modifications, reinventions, and variants have led to the description of over 700 obstetric forceps. Most of these, although fascinating, are of greatest significance only to the obstetric historian.

      For centuries, the concept of forceps was of an extricating tool, usually used in desperation as a last resort in a difficult situation. Prior to the advent of antibiotics, intravenous fluids, blood transfusion, and safe anesthesia, abdominal delivery carried horrendous maternal risk. Vaginal delivery was thus mandatory, contributing to the reputation of forceps as being associated with trauma and often tragedy.

      In 1845, Sir James Simpson designed a forceps that was scientifically calculated to the appropriate cephalic and pelvic curvatures. He encouraged the use of the forceps because the infantile mortality attended upon parturition increases in a ratio progressive with the increased duration of labor. Joseph DeLee modified that instrument and in 1920 presented his concept of the prophylactic forceps operation, asserting that the procedure protected both the maternal tissues and the fetal brain. This theory has never been scientifically proven or disproven. Although Dr. DeLee was criticized by his colleagues for interfering with nature, the concept of elective forceps was increasingly popular with practicing obstetricians. Many authors in the 1930s and 1940s reported superior outcomes for the fetus with the use of low forceps and episiotomy as compared with spontaneous delivery. Many institutions reported forceps use in over 50% of deliveries.

      Forceps designers, and their satellites and students who became teachers, taught the use only of their favorite instruments. Other types were ignored except to emphasize their disadvantages. The numerous types once in general use indicate that there is no universal forceps. Many an operator experienced a sense of relief and the thrill of success after the use of one type of forceps after failure of another type on the same patient. The reasons why one pair of forceps succeeded after another had failed came to represent the advantages of the former and the disadvantages of the latter.

      Factors were at work to slow, then reverse, the swing of the pendulum as cesarean delivery techniques improved. The safety of cesarean birth, along with the availability of blood replacement and antibiotics, made it a better alternative than a difficult forceps delivery. Other forceps indications were removed by the increased use of oxytocin in the treatment of dysfunctional labor and by improved methods of monitoring fetal status. Decreased use of general anesthesia with increased and improved conduction anesthesia techniques, though adding a few cases in which forceps were preferred, subtracted more. By the 1980s, the use of forceps had declined significantly.

      The status of forceps in modern obstetrics is constantly under discussion within the specialty. Controversy is only proper in the effort for improvement of results. As a result, many forceps types are now used sparingly while others have been dropped from use completely.

      The advent of special types of forceps was accompanied by advantages as well as disadvantages and required different techniques of application and traction. A thorough knowledge of the advantages and disadvantages of the various types of forceps, as well as the techniques for their use, was required in order to eliminate many of the adverse outcomes that resulted from following blind faith in one type or from using the trial-and-error method.

      Because today’s resident will only rarely be exposed to several of these forceps types, they are mentioned here for historic reasons.

      Barton Forceps

      Dr. Lyman G. Barton of Plattsburg, New York, designed his forceps for application to heads arrested in the transverse diameter of the inlet, especially those with a posterior parietal presentation. The instrument may be used to advantage in deep transverse arrest, oblique posterior position, and, rarely, in face presentation. The Barton forceps was presented in 1925 (Figure 1–1).

      One blade is attached to the shank by a hinge, making it flexible over an arc of 90 degrees. The other blade has a deep cephalic curve. The blades are solid and are attached to the shanks laterally at an angle of about 50 degrees, so that when the forceps is held in the anterior position, there is no pelvic curve. However, when it is rotated over an arc of 90 degrees to the transverse position, the angle of attachment of the blades to the shanks forms a perfect pelvic curve. The lock is of the sliding type. There is a separate traction handle that can be applied

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