This document describes forceps-assisted deliveries. It defines obstetric forceps as a double-bladed metal instrument used to extract the fetal head. It describes the parts of forceps including the blades, shanks, locks and handles. It discusses different types of forceps and their uses. It outlines the indications, prerequisites, technique and contraindications for a forceps-assisted delivery. Key steps include inserting the blades one at a time, applying traction in line with uterine contractions to deliver the baby. Training and experience of the operator are important to minimize risks.

1. I Z AT T Y L I M
0 3 0 8 1 8 8
FORCEPS ASSISTED
DELIVERIES

2. LEARNING OUTCOMES
• Describe the types of obstetric forceps.
• State the indications, prerequisites, contraindications
and describe the technique of obstetric forceps assisted
delivery.

3. OBSTETRIC FORCEPS
• A double-bladed metal instrument used for extraction of
the fetal head
• Parts:
• Right and left branches
• Articulation with locking or sliding mechanism
• Handles connected to blades by shanks of variable lengths
• 2 curves of the blade: cephalic & pelvic curves

4. OBSTETRIC FORCEPS
• Blades:
• grasp the fetus.
• has a curve to fit around the fetal head.
• oval or elliptical
• fenestrated or solid
• Many are curved in a plane 90° from the cephalic curve to fit the maternal pelvis
(pelvic curve).
• Shanks:
• connect the blades to the handles
• provide the length of the device.
• parallel or crossing.
• Lock:
• articulation between the shanks.
• Handles:
• to holds the device and applies traction to the fetal head.

5. TYPES OF OBSTETRIC FORCEPS
• Low cavity forceps (Wrigley’s)
• Short and light
• Also used at cesarean section
• Mid-cavity non-rotational forceps (Neville-Barnes’, Haig Ferguson,
Simpson’s)
• Used when sagittal suture is in direct anteroposterior position (usually DOA)
• Malposition (DOP/DOL) can be corrected manually between contraction & the
blades applied once head is in DOA position
• Mid-cavity rotational forceps (Keilland’s)
• Almost no pelvic curve
• Allow rotation
• Helps to correct malposition & asynclitism (fetus head not in line with
mother’s pelvis)
• Only attempted by experienced operator

7. FORCEPS ASSISTED DELIVERY
:
• Left blade inserted first before the right blade with accoucheur’s
hand protecting vaginal wall from direct trauma
• Blades lie parallel to axis of fetal head and between the fetal
head & the pelvic wall
• Articulates and locks the blades, then check the application
before applying traction
• Traction applied intermittently in concert with uterine
contraction and maternal expulsive efforts
• Axis of traction:
• guided along ‘J’-shaped curve of pelvis
• Directed vertical as head begin to crown

8. FORCEPS ASSISTED DELIVERY

9. FORCEPS ASSISTED DELIVERY
:
• Maternal.
• Maternal distress
• Exhaustion
• Undue prolongation of 2nd stage of labor
• Medically significant conditions
• Fetal.
• Malposition of fetal head (occipito-transverse and occipito-posterior)
• Fetal distress

10. FORCEPS ASSISTED DELIVERY
:
• Fully dilated cervix.
• Severe lacerations and hemorrhage may ensue if a rim of cervical tissue remains.
• Head engaged.
• The extraction of a mature fetus with a "high" (unengaged) head usually is disastrous.
• Vertex presentation or face presentation.
• Other presentations require wider-than-average pelvic diameters.
• Membranes ruptured.
• Ensure a firm grasp of the forceps on the fetal head.
• No cephalopelvic disproportion. If there is engagement, there must be no outlet
contracture or gross sacral deformity.
• Empty bladder and bowel.
• avoid laceration and fistula formation.

11. F Fully dilated os (10cm)
O Obstruction should be excluded (head ≤1/5 palpable)
R Rupture of membrane
C 1. Consent
2. Check instrument prior application
3. CPD excluded
4. Catheterize bladder
E 1. Explain procedure
2. Epidural (or pudendal) analgesia
3. Examine genital tract (exclude genital tract trauma)
P 1. Presentation & position identified
2. Pediatrician standby
S 1. Station of presenting part ( not above ischial spine )
2. Skillful operator and senior help available

12. FORCEPS ASSISTED DELIVERY
:
• Any contraindication to vaginal delivery
• Refusal of the patient to consent to the procedure
• Cervix not fully dilated/retracted
• Inability to determine the presentation & fetal head position
• Confirmed cephalopelvic disproportion
• Absence of adequate anesthesia/analgesia
• Inadequate facilities and support staff
• Inexperienced operator

13. REFERENCES
• Baker PN, Kenny LC(eds). Obstetrics by Ten Teachers. 19th ed. London: Hodder
Arnold; 2011.
• Collins S, Arulkumaran S, Hayes K, Jackson S, Impey L. Oxford Handbook of
Obstetrics and Gynaecology. 3rd ed. Collins S, Arulkumaran S, Hayes K, editors.
United Kingdom: Oxford University Press; 2013.
• Medscape: Forceps Delivery [online]. 11th December 2013. Extracted on 17th April
2015.
Available at: http://emedicine.medscape.com/article/263603-overview#a05
• Healthline: Types of Forceps Used in Delivery [online]. 15th March 2012.
Extracted on 17th April 2015.
Available at: http://www.healthline.com/health/pregnancy/assisted-delivery-types-
forceps#TypesofForceps1
• Brookside Associates: Obstetric and Newborn Care [online]. 2007. extracted on
17th April 2015.
Available at:
http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_5_Section_1.htm