Scribd
Upload
4K views11 pages

Forcep Delivery

Forceps delivery involves using obstetric forceps to extract the fetus's head when the mother is unable to deliver vaginally on her own. There are various types of forceps with different designs suited to different clinical situations. Forceps have two curved blades that are positioned around the fetal head during delivery. Indications for forceps delivery include maternal exhaustion, fetal distress, or failure of the head to descend or rotate properly during the second stage of labor. Proper technique and prerequisites such as full cervical dilation must be followed to safely perform a forceps delivery.

Uploaded by

NishaThakuri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
4K views11 pages

Forcep Delivery

Forceps delivery involves using obstetric forceps to extract the fetus's head when the mother is unable to deliver vaginally on her own. There are various types of forceps with different designs suited to different clinical situations. Forceps have two curved blades that are positioned around the fetal head during delivery. Indications for forceps delivery include maternal exhaustion, fetal distress, or failure of the head to descend or rotate properly during the second stage of labor. Proper technique and prerequisites such as full cervical dilation must be followed to safely perform a forceps delivery.

Uploaded by

NishaThakuri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 11

Forceps Delivery

Forcep delivery is a means of extraction the fetus head with the aid of obstetric
forceps when it is impossible for the mother to complete delivery by her own
effort.
Obstetric forceps is a pair of instrument specially designed to assist extraction
of the head and thereby accomplishing delivery of the fetus.

Structure of the Forceps


Obstetric forceps consist of two branches that are positioned around the fetal
head. These branches are defined as left and right depending on which side of
the mother's pelvis they will be applied. The branches usually, but not always,
cross at a midpoint which is called the articulation. Most forceps have a locking
mechanism at the articulation, but a few have a sliding mechanism instead,
allowing the two branches to slide along each other. Forceps with a fixed lock
mechanism are used for deliveries where little or no rotation is required, as
when the fetal head is in line with the mother's pelvis. Forceps with a sliding
lock mechanism are used for deliveries requiring more rotation.
The blade of each forceps branch is the curved portion that is used to grasp the
fetal head. The forceps should surround the fetal head firmly, but not tightly.
The blade characteristically has two curves, the cephalic and the pelvic curves.
The cephalic curve is shaped to conform to the fetal head. The cephalic curve
can be rounded or rather elongated depending on the shape of the fetal head.
The pelvic curve is shaped to conform to the birth canal and helps direct the
force of the traction under the pubic bone. Forceps used for rotation of the fetal
head should have almost no pelvic curve. The handles are connected to the
blades by shanks of variable lengths. Forceps with longer shanks are used if
rotation is being considered.

Types of forceps
Long curved forceps: Long curved forceps is relatively heavy and is about 37
cm (15) long. It has blade, shank, Lock, handle with or without screw.

Simpson forceps (1848) are the most commonly used among the types of
forceps and has an elongated cephalic curve. These are used when there is
substantial molding, that is, temporary elongartion of the fetal head as it moves
through the birth canal.
Elliot forceps (1860) are similar to Simpson forceps but with an adjustable pin
in the end of the handles which can be drawn out as a means of regulating the
lateral pressure on the handles when the instrument is positioned for use. They
are used most often with women who have had at least one previous vaginal
delivery because the muscles and ligaments of the birth canal provide less
resistance during second and subsequent deliveries. In these cases the fetal head
may thus remain rounder.
Kielland forceps (1915, Norwegian) are long almost straight distinguished by
an extremely small pelvic curve and without anu axis traction device and has
sliding lock. Probably the most common forceps used for rotation. The sliding
mechanism at the articulation can be helpful in asynclitic births (when the fetal
head is tilted to the side), since the fetal head is no longer in line with the birth
canal. On the other hand, Kielland forceps lack traction because they have
almost no pelvic curve.
Wrigley's forceps (Short curved obstetric forceps) are used in low or outlet
delivery (see explanations below), when the maximum diameter is about 2.5 cm
above the vulva. Wrigley's forceps were designed for use by general practitioner
obstetricians, having the safety feature of an inability to reach high into the
pelvis. Obstetricians now use these forceps most commonly in cesarean section
delivery where manual traction is proving difficult. The short length results in a
lower chance of uterine rupture.
Piper's forceps have a perineal curve to allow application to the after-coming
head in breech delivery.

Parts of the forceps:

Blade: Obstetric forceps consist two separate blades, each with handle. Each
blade is marked L (left) or R (right). Blade has two curves that are pelvic curve
and cephalic curves. The cephalic curve which permit an accurate and safe grip
of the fetal head and are spoon shaped. The pelvic curve which confirms to the
axis of the birth canal.The tip of the blade called toe.
Shank: It is the part between the blade and the lock. It facilitates locking blade
outside the vulva.
Lock: the lock is located on the shank at its junction with the handle.
Handle: the handles are apposed when the blades are articulated and apply
traction to the fetal head.

Elliott forceps with "pressure regulating" screw at the end of handles USA (1860

Classification of forceps delivery according station


Outlet, low, mid or high
The accepted clinical standard classification system for forceps deliveries
according to station and rotation was developed by ACOG and consists of:
1. Outlet forceps delivery, where the forceps are applied when the fetal head
has reached the perineal floor and its scalp is visible between
contractions.This type of assisted delivery is performed only when the fetal
head is in a straight forward or backward vertex position or in slight rotation
(less than 45 degrees to the right or left) from one of these positions.
2. Low forceps delivery (90%), when the baby's head is at +2 station or lower.
There is no restriction on rotation for this type of delivery.
3. Midforceps delivery (10%), when the baby's head is above +2 station. There
must be head engagement before it can be carried out, rotation >450

4. High forceps delivery is not performed in modern obstetrics practice. It


would be a forceps-assisted vaginal delivery performed when the baby's
head is not yet engaged.
Types of application of forceps blades
1. Cephalic application
The blades are applied along the sides of the grasping the biparietal
diameter in between the widest part of the blades. The long axis of the
blades corresponds more or less to the occipito-mental plane of fetal head. It
is the ideal method of application as it has got a negligible compression
effect on the cranium.
2. Pelvic application
When the blades of the forceps are applied on the lateral pelvic walls
ignoring the position of the head, it is called pelvic application. If the head
remains unrotated, this type of application puts serious compression effect
on the cranium and thus must be avoided.
Indications of forcep delivery
Maternal
1.
2.
3.
4.
5.

Inadequate expulsive efforts


Maternal exhaustion (distress) in second stage
Delayed second stage of labour.
Pre-eclampsia, eclampsia
Post caesarean pregnancy

6. Maternal illness; such as heart disease, hypertension, glaucoma,


aneurysm, pulmonary disease, which make pushing difficult or dangerous
7. Malposition: occipito posterior and occipito lateral positions.
8. Neurological disorders where voluntary efforts are contraindicated.
9. Failure of descent or internal rotation for 2 hours in primigravidae and 1
hour in multipara.
Fetal indication

1.
2.
3.
4.
5.
6.

Fetal distress in second stage of labour


vertex presentation or face presentation
After coming head in breech delivery
Low birth weight baby
Post maturity
Cord prolapse in second stage of labour

Contraindication
1.
2.
3.
4.
5.

Absence of proper indication


Absence of full dilatation of cervix
CPD
High station of fetal head
Uterine contraction cease.

Advantages
1.
2.
3.
4.
5.

Avoidance of C-section
Reduction of delivery time
Can be used for pre term delivery
Can be used for face and after coming head of breech.
General applicability with cephalic presentation.

Disadvantage
1. Difficult to apply
2. More likely to cause trauma to both mother and baby

Pre requisite for forcep delivery


1. Cervix must be fully dilated
2. The fetal head at +2 or +3 station or 0/5 palpable above the symphysis
3.
4.
5.
6.
7.

pubis
The sagital suture should be in the middle
The membranes must be absent
Bladder must be empty
The rectum should be empty
The uterine contraction must well

8. Suitable presentation and position


9. Adequate analgesia (lacal anaesthesia)
10.There should be no cephalopelvic disproportion
11. Baby must be living.
Equipments for forcep delivery
1.
2.
3.
4.
5.

Normal delivery set


Episiotomy set
Cather
Sterile obstetric forecp 1 pair
Resuscitation trolley for baby

Procedures:
1. Explain the mother about the purpose and procedure
2. Take written consent
3. Prepare the sterilized delivery set, episiotomy set, forceps, catheter,
emergency medicine, resuscitation set, suction, oxygen etc.
4. Inform pediatrician and make ready all the necessary equipments and
articles.
5. Mother is placed in lithotomy position.
6. Put the personal protective barriers.
7. Wash vulva with antiseptics solution, drapping is placed.
8. Empty the bladder with catheterization.
9. Give the episiotomy when indicated.
10.Check the forceps before application that is parts fit together and lock
well and lubricate the blade of the forceps.
11.The left blade is applied first. Insert two fingers (middle and index) of the
right hand into the vagina on the side of the fetal head. Slide the left blade
gently between the head and fingers to rest on the side of head.
12. Introduce the right blade in same manner as with left blade but with right
hand.The left blade is introduced by left hand into left side of pelvis and
right blade is introduced by right hand into right side of pelvis as follows
two or more fingers of the right hand are introduced inside the left
postero lateral portion of the vulva and into the vagina beside the head.
13.Depress the handles and lock the forceps. Difficulty in locking forceps
and the handles are depressed on the perinium indicates that the

application is incorrect. If incorect application, remove the blade and


recheck the position of head.
14. After locking the handles of the forcep are gripped with the right hand
and apply steady traction downwards, downwards forward and finally
upwards with each contraction.
15. Between contractions check fetal heart rate and application of forceps.
16. Thus the head is delivered by extension.
17. Remove the forceps after delivery of head.
18. Clean the eyes, nose and mouth of the baby. Then proceed as in normal
delivery.
19. Examined the baby carefully for injury or trauma caused by forceps.
20. Manage the third stage of labour actively.
21. If vaginal or cervical injury is present repair it.
22. Resuscitate the newborn if needed and keep the newborn warm with skin
to skin contact.
Failure:
Forceps fails if:
1. Fetal head does not advance with each pull, only 2 or 3 pull should be
necessary.
2. Fetus is undelivere after three pulls with no descent or after 30 minutes.
3. Dont persist if the head does not descend with every pull.
Complications
Fetal
Soft tissue injury to face and bruises
Occasionally, (usually temporary) facial nerve injury can occur
rarely, clavicle fracture
Intracranial hemorrhage sometimes leading to death
Cephalohaematoma

Brain damage
Facial palsy/ brachial palsy
Cord compression
Remote cerebral palsy
Infection
Convulsion
Mother
Increased postnatal recovery time and pain
problems going to the toilet during the recovery time
Tears of the genital tract
Uterine rupture
Injury to bladder or rectum
Post partum haemorrhage due to atonic or trauma
Vesico vaginal and recto vaginal fistula
Shock
Fracture of sacro-coccygeal joint
Pelvic haematoma
Genital prolapse

Extension of episiotomy

You might also like