Forceps Delivery

Forceps
delivery
Introduction
• The obstetric forceps operations is used in the
interest of the mother or the baby and when
properly performed can be a rewarding
experience and also lifesaving.
• The forceps has inbuilt functions which
permits traction, rotation, dilatation,
compression and irritation of the uterus,
stimulating it to contract when traction is
made.
Operative Vaginal Delivery
Forceps Delivery
Meaning
• Obstetric forceps is a pair of instrument specially
designed to assist extraction of the head and there by
accomplishing delivery of fetus.
• Forceps Delivery is a means of extracting the fetus with
aid of obstetric forceps when it is inadvisable or
impossible for the mother to complete the delivery by her
own efforts.
• Forceps are also used to assist the delivery of the after-
coming-head of the breech & on occasion to withdraw the
head up & out of the pelvis at caesarean section.
CLASSIFICATION OF FORCEPS
DELIVERY
• Ever since the invention of obstetric forceps
around 1,600 AD by the WILLIAM
CHAMBERLAIN family, many designs were
invented & modified.
• Forceps Deliveries were formerly classified by
the level of the head at the time the forceps were
applied, i.e High-cavity, mid-cavity & low-cavity
• Low-cavity forceps is frequently performed as
C.S is alternative for more traumatic high & mid-
cavity operations.
Classification of forceps according to station
Low Foetal scalp is visible without separating the vulva
forceps Foetal skull has reached the pelvic floor
Sagital suture is in the A.P.diameter or in the Lt./Rt.
Occiputo anterior/posterior position
Rotation does not exceed 45degrees
Outlet The leading point of the skull is 2cm or more below the
forceps ischeal spine but not on the pelvic floor
Sagital suture is in the A.P.diameter or in the Lt./Rt.
Occiputo anterior/posterior position
Mid The leading point of the skull is 2cm or less above the spine
forceps but head is engaged. Rotation not considered
High EXCLUDED
forceps
Types of obstetric forceps
currently used
• Only three verities are commonly used in
present day obstetrics. They are
• Long-curved forceps with or without axis
traction device
• Short-curved forceps ( wrigley’s)
• Kielland’s forceps
Kielland’s forceps
• Long, almost straight (very slight pelvic curve),
without any axis traction device
• Has sliding lock
• Used when the head is in an occipito lateral or
occipito-posterior position (un-rotated vertex or
face presentation)
Functions of forceps
• Traction: -This is the most important
function.
• Compression effect: -This is minimal when
properly applied & should not be more than
necessary to grasp the head. However it has
some pressure effect on the well-ossified
base of the skull.
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• Rotation of head: -This occurs with the use of
Kielland's forceps and also in low forceps
cephalic application with the occiput in the 2 or
10 'o' clock position.
• Protective cage: - When applied on the after
coming head it lessens the sudden
decompression effect.
• As a vectis: - By applying one blade to deliver
the head in caesarean section.
Indications for forceps delivery
 Delay in second stage: -.
– Due to uterine inertia.
– Failure of progress of labour- if no progress occurs
for > 20 to 30 minutes, with the head on the
perineum.
Maternal indications
• Maternal distress
• Pre-eclampsia, eclampsia in second stage of labour.
• Maternal medical disorders like Heart disease,severe
anaemia, tuberculosis, to shorten the second stage of
labour.
• Malposition : occipito posterior, occipito lateral
position
 Foetal indications: -
– Foetal distress in second stage when prospect of
vaginal delivery is safe: -
• Abnormal heart rate pattern
• Passage of meconium
– Cord prolapse in second stage
– After coming head of breech
– Post maturity
Prerequisites
(to be fulfilled before forceps application.)
• Suitable presentation & position: -.

– Vertex, anterior face or after-coming head are the
ideal positions.
– Fetal head engaged (head is ≤⅕ palpable per
abdomen)
– Fetal head position is exactly known
• Cervix must be fully dilated.
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• Membranes must be ruptured.
• Baby should be living.
• Uterus should be contracting & relaxing.
• Bladder must be empty.
• F- fetal position & presentation (vertex, engaged,
position is exactly known)
• O- os fully dilated cervix
• R- ruptured membranes
• C- cephalic presentation
• E- empty bladder
• P- pelvis adequate
• S- stir up position (lithotomy position)
Preliminaries (before forceps application )
• Informed consent with prior clear explanation
• Documentation: - include:
– Consent of the patient,
– indication for operation,
– anaesthesia,
– personnel involved,
– type of instrument,
– difficulties & remedies,
– resulting maternal & foetal complications or
injuries and blood loss.
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• Anaesthesia:-
– Pudendal block or Labio-perineal infiltration
for outlet forceps.
– Regional or General anaesthesia for low & mid
forceps.
• Catheterisation:-
• Internal examination: To asses the state of
cervix & membranes, presentation & position,
pelvic outlet, TDO & sub pubic angle.
• Episiotomy: -
– Should be done either before application of forceps or
during traction when the perineum bulges.
[p
Complications / Dangers
Complications/dangers of forceps delivery are
mostly due to faulty technique rather than the
instrument.
• Maternal-
– Injury-.
• Extension of the episiotomy involving anus &
rectum or vaginal vault.
• Vaginal lacerations and cervical tear
– Post partum haemorrhage –.
• Due to trauma, Atonic uterus or Anaesthetisia.
28
–Shock
• Due to blood loss, dehydration or
prolonged labour.
–Sepsis
–Delayed or long-term sequel
• Chronic low backache, genital prolapse &
stress incontinence.
• Fetal Complications / Dangers
– Asphyxia.
– Trauma
• Intracranial haemorrhage.
• Cephalic haematoma.
• Facial palsy
• Brachial palsy.
• Injury to the soft tissues of face & forehead.
• Skull fracture
– Remote-cerebral palsy.
– Foetal death-around 2%. 30
Prophylactic/Elective forceps
Introduced by Dee Lee (1920), refers to outlet
forceps delivery, only to shorten the second stage
of labour to prevent anticipated maternal or foetal
complications in -
• Eclampsia
• Heart disease
• Previous c.s.
• Post maturity
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Failed forceps
• When a delibrate attempt in vaginal delivery
with forceps has failed to expedite the
process, it is called failed forceps
• Mostly it is due to lack of obstetric skill and
poor clinical judgment
• Failure may be improper application or
failure of descend of the head even with
forcible contraction
• Factors responsible are- Disproportion,
Incomplete cervical dilatation & malposition
of foetal head
Management of failed forceps
• Asses the effect on mother & fetus
• Start I.v infusion with 5% dextrose if not
started already
• Administer parental antibiotic
• Exclude rupture of uterus & plan for other
modes of delivery
• Shift the woman to an equipped hospital
Towards a safe motherhood
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Forceps

• Suitable presentation & position: -.

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