Obstetric forceps are metal instruments used to extract the fetal head during delivery, with various applications based on fetal position and maternal conditions. Indications for use include prolonged labor, maternal distress, and specific fetal conditions, while contraindications include prematurity and unengaged heads. Forceps delivery carries risks for both mother and child, including potential lacerations and fetal injuries, necessitating proper prerequisites such as anesthesia and engaged fetal head.

1. FORCEP DELIVERY Made by:
Ramsha Marwat

2. Definition:
 Obstetric forceps is a double-bladed metal
instrument used for extraction of foetal head.
 This instrument is applied to foetal head and
then the operative uses traction to extract the
foetus, typically during a contraction while
the mother is pushing.

3. Design of forcep:
Basically it consist of two crossing branches.
Each branch has four components:
1. Blade
2. Shank
3. Lock
4. Handle
Each blades has two curves
 Cephalic curve to shape of foetal head
 Pelvic curve to pelvic curvature.

5. CLASSIFICATION OF FORCEP DELIVERY
 Outlet = Wrigley’s
 Outlet & low forceps = Simpson/Elliot
 Mid forceps = Tucker Mclane
 Midforceps & rotation = Kielland
 After coming head in breech = Piper

7. Types of Forceps:

11. TYPES OF FORCEPAPPLICATION
 CEPHALIC APPLICATION:
 The forceps is applied on the sides of the foetal head in the mento-
vertical diameter so, injury of the fetal face, eyes and facial nerve
is avoided.
 PELVIC APPLICATION:
 The forceps is applied along the maternal pelvic wall irrespective
to the position of the head.it is easier for application but carries a
great risk of foetal injuries.
 CEPHALO-PELVIC APPLICATION:
 It is the ideal and possible application when the occiput is directly
anterior or in mento-anterior diameter position.

13. ACTION OF TRACTION
 Traction: is the main action.
 Rotation: in deep transverse arrest, persistent
occipito-posterior and mento-posterior.

14. INDICATIONS OF FORCEP DELIVERY
 Prolonged 2nd stage
 It is the prolongation for more than 1 hour in
primigravidae or 30 mins in multiparae. This may
be due to:
 Poor voluntary bearing down
 Large fetus
 Rigide perineum
 Malposition: persistent occipito posterior and
deep transverse arrest.

15. MATERNAL INDICATIONS
 Maternal distress are manifested by
 Exhaustion
 Pulse greater than 100 beats per min
 Temperature greater than 38 C
 Sign of dehydration
 Maternal diseases as:
 Heart disease
 Pulmonary TB
 Pre eclampsia and eclampsia

16. FOETAL INDICATIONS
 Fetal distress
 Prolapsed pulsating cord
 Preterm delivery
 After coming head in breech delivery

17. PRE-REQUISITIES FOR FORCEPS
APPLICATION
 Anesthesia: general ,epidural, spinal, pudental
block.
 Adequate pelvic outlet.
 Aseptic measures
 Bladder and bowel evacuation
 Contractions of the uterus should be present.
 Dilatation of the cervix should be fully.
 Engaged head.

18. PRE-REQUISITIES FOR FORCEPS
APPLICATION
 Forewater rupture
 Favourable position and presentation:
 occipito anterior
 occipito posterior
 face presentation
 after coming head in breech

19. MANAGEMENT:
 Re-assessment: the forcep is removed and the
patient is re-examined to detect the cause and
correct it if possible.
 Caesarean section: it is indicated in
uncorrectable causes as CPD and contracted
outlet.
 Exploration of the birth canal: for any injuries.

20. CONTRAINDICATIONS
 Fetal prematurity
 Known fetal dimineralizing diseases (e.g
osteogenesis imperfecta)
 Unengaged head
 Unknown fetal position
 Malpresentation

21. MATERNAL COMPLICATIONS
Complications of anesthesia
 Lacerations:
 extentions of the episiotomy
 perineal tear
 vaginal tear
 cervical lacerations
 bladder injury
 rupture uterus
 pelvic nerve injuries
 puerperal infections

22. FETAL COMPLICATIONS
 Fracture of the skull
 Intracranial haemorrhage
 Facial nerve palsy
 Trauma to the eyes ,face, scalp.