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FORCEP DELIVERY Made by:
Ramsha Marwat
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.
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.
Forcep delivery
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
Forcep delivery
Types of Forceps:
Forcep delivery
Forcep delivery
Forcep delivery
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.
Forcep delivery
ACTION OF TRACTION
 Traction: is the main action.
 Rotation: in deep transverse arrest, persistent
occipito-posterior and mento-posterior.
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.
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
FOETAL INDICATIONS
 Fetal distress
 Prolapsed pulsating cord
 Preterm delivery
 After coming head in breech delivery
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.
PRE-REQUISITIES FOR FORCEPS
APPLICATION
 Forewater rupture
 Favourable position and presentation:
 occipito anterior
 occipito posterior
 face presentation
 after coming head in breech
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.
CONTRAINDICATIONS
 Fetal prematurity
 Known fetal dimineralizing diseases (e.g
osteogenesis imperfecta)
 Unengaged head
 Unknown fetal position
 Malpresentation
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
FETAL COMPLICATIONS
 Fracture of the skull
 Intracranial haemorrhage
 Facial nerve palsy
 Trauma to the eyes ,face, scalp.
Forcep delivery

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Forcep delivery

  • 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
  • 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.