For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
For difficult vaginal delivery,forceps delivery,vacuum application are done to assist the vaginal delivery.Many types of forceps are there divided in 3 categories.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
A review of clinical pelvimetry and its usefulness in determining if a operative vaginally delivery may be performed. Multiple types of forceps are reviewed. This is a must read for all obstetric providers.
LSCS is the most common obstetric procedure but it can be very difficult to manage in cases of previous LSCS, low lying placenta, and PPH. please check out the youtube links to the videos embedded in this PPT.
ADHESIOLYSIS DURING LSCS https://youtu.be/2Hv80v3yu20
BLADDER DISSECTION https://youtu.be/6qsaTJ1yRUY
RECTUS SHEATH ADHESIOLYSIS https://youtu.be/SryJHjuGsME
VECTIS IN FLOATING HEAD DURING LSCS https://youtu.be/3PECperU8Cw
BREECH DELIVERY https://youtu.be/i-LcmTNNVvU
TRANSVERSE LIE WITH IUFD https://youtu.be/hG28uqpkdpU
CONJOINT TWINS https://youtu.be/KLR7D6wkf38
LSCS IN PLACENTA PREVIA https://youtu.be/dNKQwt4KhVY
SYSTEMATIC PELVIC DEVASCULARISATION https://youtu.be/UwSH6V6GBVw
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
Clinical pelvimetry and Forceps Assisted Vaginal DeliveryArthur Greenwood
A review of clinical pelvimetry and its usefulness in determining if a operative vaginally delivery may be performed. Multiple types of forceps are reviewed. This is a must read for all obstetric providers.
Brief overview of operative vaginal delivery as a method of expediting the second stage of labor. The presentation covers both forceps and vacuum delivery including their indications, applications and complications.
Forceps delivery Guest lecture presented at thr West Zone YUVA FOGSI Udaipur in July 2018, Dfination, Clasification, Prerequisites, Indications, Contraindications, Complication Maternal and Fetal,
Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
Forceps are the instrument which are used to extract the fetal head. There are different types of instrument shown in this slide. Indications and contraindications to use this Instrument.
PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor. dr . m. gokul reshmi, dr. gokulreshmi m
PELVIC ORGAN PROLAPSE, uterine prolapse , cystocele, rectocele, urethrocele, supports of uterus, sling surgeries, pessaries, grades of prolapse, uterine preserving surgery for pop, pelvic floor repair, vaginal hysterectomy, ward mayos surgery, pop q grading, grading of prolapse, laproscopic surgeries for prolapse, peregee, apogee , mesh repair, tot, tvt, colpo suspension, colpoclysis, SUI management, epidemiology of prolapse, decubitus ulcer, best ppt for pelvic organ prolapse, better understanding of pelvic organ prolapse and pelvic floor.
dysmenorrhea ,dysmenorrhea definition, types of dysmenorrhea, menstrual pain , pathophysiology of dysmenorrhea, management of primary dysmenorrhea, management of secondary dysmenorrhea, treatment of dysmenorrhea.
Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
fibroid, endometriosis, medical management of fibroid, medical management of endometriosis, drug theraphy, hormonal, non hormonal. gnrh. aromatase inhibitor,COC, PAIN FULL MENSES,
REPRODUCTIVE AND CHILD HEALTH, national scheme, RCH, Maternal health, neonate, maternal and child health, Family planning program, Child survival & safe motherhood program, Components of RCH , Adolescent health care and family life education,
post term pregnancy, post dated pregnancy, prolonged pregnancy,
m.g. reshmi, management of post dated pregnancy,management of post term pregnancy, fetal maturity assesment, post maturity syndrome, mortality and morbidity ,placental dysfunction, aminotic fluid volume in prolonged pregnancy.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. HOW IT WORKS
• Once either is applied to the fetal head, outward traction generates
forces that augment maternal pushing to deliver the fetus vaginally.
• The most important function of both devices is traction.
• Forceps used for rotation (particularly from occiput transverse and
posterior positions), traction , or simple lift out.
4. INCIDENCE
• The incidence of operative vaginal delivery varies widely.
• Ranges from 3 to 5%
• Vacuum is disproportionately selected, and the vacuum-to-forceps
delivery ratio is nearly 5:1.
6. HISTORY
• Morden obstetric forceps - Peter Chamberlen 17th Century
kept secret for nearly 150 years
and surfaced in 1813.
• Forceps with cephalic
And pelvic curve - Sir James Simpson in 1845.
• Detachable angled traction
rods and traction handle - Milen Murray(1891) &
Neville(1886).
7. HISTORY
• Rotational forceps for DTA - Christian Kielland (1915)
• After coming head of
the breech - Edmund Piper (1929)
• Short light forceps - Wrigley
generous cephalic curve (1935)
• pseudo—fenestrated blades - Luikart (1937)
8. INDICATIONS
Maternal:
•Inadequate expulsive efforts
• Maternal exhaustion (distress)
• Where expulsive efforts (valsalva) are to be avoided (cerebrovascular
diseases, cardiac disease Class III or IV, hypertensive crises, myasthenia
gravis, spinal cord injury patients at risk of autonomic dysreflexia,
proliferative retinopathy)
9. INDICATIONS
Fetal:
• Non-reassuring fetal heart rate: fetal distress (e.g. low birth weight
baby, post-maturity)
• After coming head of breech , OP, OT, Face presentation
mentoanterior.
• Suspicion of fetal compromise
10. INDICATIONS
Others:
• Prolonged second stage of labour (Nullipara > 2 h; multipara > 1 h)
•To cut short the second stage of labour as in severe pre-eclampsia,
cardiac disease, post cesarean pregnancy
11. CONTRAINDICATIONS
Absolute contraindication:
• An ungagged head
• Unknown fetal position
• Malpresentation(brow , mentoposterior)
Relative contraindication:
• Fetal bleeding disorders (thrombocytopenia)
• Maternal HIV
• Cephalopelvic disproportion.
12. PREREQUISITES
Maternal criteria:
• Adequate analgesia
• Lithotomy position
• Bladder empty
• Clinical pelvimetry must be
adequate in dimension and size
to facilitate an atraumatic
delivery .
• Verbal or written consent .
14. PUDENTAL BLOCK
• A 20 mL syringe with 15 cm (6”) 22
gauge spinal needle and about 20
mL of 1% lignocaine hydrochloride
used for pudendal block .
• The needle is passed into the
vaginal wall on the apex of ischial
spine and thereafter to push a little
to pierce the sacrospinous ligament
just above the ischial spine tip.
• About 10 mL of the solution is
injected. similarly procedure is
repeated on the other side.
15. PREREQUISITES
Fetal criteria:
• Vertex presentation
• Fetal head must be engaged in
pelvis
• Fetal weight estimated
• Position of fetal head must be
known
• Attitude of fetal head and presence
of caput succedaneum and/or
molding should be noted
• No fetal coagulopathy
• No fetal demineralization disorder
17. PREREQUISITES
Other criteria:
• Experienced operator, trained with the use of the instrument.
• Willingness to abandon OVD in case of failure.
• The capability to perform an emergency cesarean delivery if
required.
20. DESCRIPTION AND TYPES OF FORCEPS
(A) Long-curved with axis traction
device;
(B) The same with attached axis
traction device;
(C) Wrigley’s
(D) Kielland’s
21. DESCRIPTION AND TYPES OF FORCEPS
Name of forceps Level / use Features
Wrigley’s forceps Outlet forceps
Simple liftout
Cesarean section
Short, light forceps
Cephalic and pelvic curves
English lock
Simpson’s forceps
Elliot’s forceps
Low forceps Longer forceps
Cephalic and pelvic curves
English lock
Milne Murray’s forceps Low / mid forceps Axis traction forceps
Has traction rods and handle
Has cephalic , pelvic and perineal
curves
English lock , nut, and screw
Traction along curve of Carus.
Traction forceps
22. DESCRIPTION AND TYPES OF FORCEPS
Name of forceps Level / use Features
Kielland’s forceps Midforceps Cephalic and minimal pelvic curves
Sliding lock
Used in occipitotransverse position
Correct asynclitism
Barton’s forceps Midforceps One blade hinged
Sliding lock
Cephalic curve
Rotational forceps
23. DESCRIPTION AND TYPES OF FORCEPS
Name of forceps Level / use Features
Pipper’s forceps Aftercoming head
In breech delivery
Long shaft
Cephalic , pelvic , and perineal
curves
English lock.
Special forceps
24. DESCRIPTION AND TYPES OF FORCEPS
• Simpson forceps
• Low forceps
• Fenestrated blades, parallel
shanks, and English lock.
• The cephalic curve
accommodates the fetal head
25. DESCRIPTION AND TYPES OF FORCEPS
WRIGLEY’S FORCEPS:
• Outlet forceps.
• Short curved obstetric forceps.
• Generous cephalic curve.
• English lock.
26. DESCRIPTION AND TYPES OF FORCEPS
Kielland’s forceps:
• Midforceps
• Light weight.
• Cephalic and minimal pelvic
curves
• Sliding lock
• Used in occipitotransverse
position
• Correct asynclitism
27. DESCRIPTION AND TYPES OF FORCEPS
Parts of obstetric forceps:
• Two half with a lock
• Fenestrated blade
• Shank English lock
• Lock Nut and screw lock
• Handle Sliding lock
• Finger guard
• Cephalic curve
• Pelvic curve
• Perineal curve
28. ACOG classification of forceps deliveries
Outlet forceps
1.Scalp is visible at the introitus without separating the labia .
2. Fetal skull has reached the level of the pelvic floor .
3. Sagittal suture is in the direction anteroposterior diameter or in the right or left
occiput anterior or posterior position .
4. Fetal head is at or on the perineum .
5. Rotation does not exceed 45 degree.
29. ACOG classification of forceps deliveries
Low forceps Leading point of the fetal skull (station) is station +2 or more but has
not yet reached the pelvic floor .
Rotation <45 degree(LOA/ROA to OA)or (LOP/ROP to OP).
Rotation>45degree including OP.
Mid‐forceps The head is engaged in the pelvis but the presenting part is above
+2 station .
Rotation <45 degree(LOA/ROA to OA)or (LOP/ROP to OP).
Rotation>45degree including OP.
High forceps (Not included in this classification)
31. MORBIDITY
• There is an increased risk of certain morbidities for both mother and
fetus with operative vaginal delivery.
• Maternal Morbidity
• Perinatal Morbidity
32. Maternal Morbidity
• Injuries
• Perineal lacerations
• Need for episiotomy
• Vaginal and cervical tears
• Traumatic postpartum hemorrhage
• Long term
• Urinary incontinence
• Anal sphincter dysfunction
• Puerperal endometritis
33. Perinatal Morbidity • Soft tissue injury to face
• Facial nerve palsy
• Intracranial hemorrhage
• Cephalhematoma
34. FORCEPS DELIVERY
Assessment before forceps
delivery:
• Abdominal examination
• Uterine contraction
• Descent of head
• FHR
• Weight of the baby
• Vaginal examination
• Cervical dilatation
• Rupture of membranes
• Colour of liquor
• Caput succedaneum
• presenting part
• Station
• Flexion
• Asynclitism
• Position
• Degree of molding
35. APPLICATION OF FORCEPS
For OA or LOA positions, the left handle of
the forceps is held in the left hand. The blade
is introduced into the left side of the pelvis
between the fetal head and the fingers of the
operator’s right hand.
Insertion arc of the blade. Importantly, the
thumb of the right hand, guides the blade
during placement.
36. APPLICATION OF FORCEPS
• In applying the second blade,
insertional force is generated
mainly by the thumb.
37. CHECKING FOR ACCURATE APPLICATION
• The blades are constructed so
that their cephalic curve is
closely adapted to the sides of
the fetal head.
• The fetal head is perfectly
grasped only when the long axis
of the blades corresponds to the
occipitomental diameter.
• As a result, most of the blade
lies over the lateral face.
38. CHECKING FOR ACCURATE APPLICATION
• The sagittal suture - perpendicular
to the shanks and equidistance
from two blades.
• Posterior fontanel – midway
between blades and one finger
breath anterior to the line joining
the shanks.
• A small part of the fenestration of
the blade to be felt on either side.
39. • Branches are removed in the
opposite order from that in
which they were originally
placed.
• The fingers of the right hand,
covered by a sterile towel,
bolster the perineum.
• The thumb is placed directly on
the head to prevent sudden
egress.
40. TRACTION• Outlet forceps : upward to
complete extension of head.
• Low forceps : horizontal until
head crowns and perineum
buldges f/b upward traction.
• Mid forceps : downward and
backward initially f/b upward
and forward and finally upward.
The vector changes with fetal descent.
41. TRACTION - OP
• In OP - horizontal until the root of
the nose hitches under the pubic
symphysis, upward and forward
until occiput is delivered and
downward and backward for the
nose, face, and chin to be born.
• The head should be flexed after the
bregma passes under the
symphysis.
42. ROTATION
If LOA, the vertex is rotated from this
position to OA
• If rotation is <45degree short of
full rotation ,application should
be cephalic with blades over
parietal bones . Vx rotates when
traction is applied .
• If rotation is >45degree, manual
rotation can be tried first if
failed, forceps can be applied
and rotation occurs during
traction.
43. ROTATION - OT
Wandering method
• A. Application of the right branch of
the Kielland forceps to a head in LOT
position. The knob on this branch will
ultimately face the occiput.
• B. The right branch is wandered to its
final position behind the symphysis.
• C. Insertion of the left branch of the
Kielland forceps directly posterior
along the hollow of the sacrum. This
branch is inserted to the maternal
right of the anterior branch to aid in
engaging the sliding lock.
44. MENTUM ANTERIOR FACE PRESENTATION
• The blades are applied to the sides of the head along the
occipitomental diameter, with the pelvic curve directed toward the
neck.
• Downward traction is exerted until the chin appears under the
symphysis. Then, by an upward movement, the face is slowly
extracted, with the nose, eyes, brow, and occiput appearing in
succession over the anterior margin of the perineum.
45. DELIVERY OF THE AFTERCOMING HEAD
Piper forceps
• A. The fetal body is held elevated
using a warm towel and the left
blade of forceps is applied to the
aftercoming head.
• B. The right blade is applied with
the body still elevated.
• C. Forceps delivery of the
aftercoming head.
46. TRIAL OF OPERATIVE VAGINAL DELIVERY
• Assisted vaginal births that have a higher risk of failure should be
considered a trial and be attempted in a place where immediate
recourse to caesarean birth can be undertaken.
47. Failed forceps
Higher rates of failure are associated with:
• Maternal BMI greater than 30
• short maternal stature
• estimated fetal weight of greater than 4 kg or a clinically big baby
• head circumference above the 95th percentile
• occipito–posterior position
• midpelvic birth or when one-fifth of the head is palpable per
abdomen.
48. Failed forceps
• When difficulty is not anticipated in forceps delivery but attempt fails
is known as failed forceps.
• Maternal and neonatal morbidity are high with failed forceps.
• Forceps delivery should be abandoned if :
• There is difficulty in application of the blades
• There is no progressive descent with moderate traction.
• Delivery is not imminent after three pulls.
49. Failed forceps
Laufe’s principle of failed forcep
• Forceps fail not only when vaginal extraction is not possible but also if
after undue pulling there is considerable damage to maternal soft
parts and the baby, which has been delivered, has suffered
considerable injury with low APGAR score and meager chances of
survival
50. VENTOUSE EXTRACTION
• Ventouse is an instrumental device designed to assist delivery by
creating a vacuum between it and the fetal scalp.
51. HISTORY
• Double valved piston with a metal cup – James Young Simpsom
• Tage Malmstorm in 1953 described the most successful model.
52. INDICATIONS
• The indications are same as those of forceps except that it cannot be
employed in face or after coming head of breech.
• Shortening second stage of labour
• Maternal Exhaustion
• Presumed fetal distress
• Occipito- Posterior position
• To deliver second twin if head is presenting part
53. CONTRAINDICATION
• Gestational age <34 weeks ( risk of IVH)
• Malpresentations
• Cephalopelvic disproportion
• Fetal bleeding disorder
• Maternal HIV infection.
54. PREREQUISITES
• Bladder should be empty
• Cervix fully dilated
• Cephalic presentation
• Head 1/5th palpable
• Station + 2 or below
55. DESCRIPTION AND TYPES
• Rigid cups
• Rigid metal cup (Malmstrom cup)
• Rigid plastic, polyurethane, or polyethylene cups
• Soft cups
• Soft silastic / plastic cups.(Kiwi cup)
• Bird’s cup : tube attached excentrically near the rim of the cup. Used
for OP and OT. Position.
56. Difference b/w Soft and Rigid cup
SOFT CUPS RIGID CUPS
More likely to fail
Less scalp injury
More suitable for OA position.
Size :50, 60mm.
Chignon not formed
Less likely to fail
More scalp injury
More suitable for OP positions, asynclitism and larger
fetus
Size : 40, 50, 60mm.
Chignon formed
59. CHIGNON FORMATION
• The scalp is sucked into the cup
and an artificial caput
succedaneum (chignon) is
produced.
• The chignon usually disappears
within few hours.
• Chignon in french : a knot of hair
that is worn at the back of the
head
60. MORBIDITY
• Episiotomy; vacuum, 50–60%; and forceps, more than or equal to
90%.
• Significant vulvo–vaginal tear; vacuum, 10%; and forceps, 20%.
• Postpartum haemorrhage; vacuum and forceps, 10–40%.
• Urinary or bowel incontinence; common at 6 weeks, improves over
time.
Maternal outcomes:
61. MORBIDITY
Perinatal outcomes:
• Cephalhaematoma; predominantly vacuum, 1–12%.
• Facial or scalp lacerations; vacuum and forceps, 10%.
• Retinal haemorrhage; more common with vacuum than forceps, variable 17–38%.
• Jaundice or hyperbilirubinaemia; vacuum and forceps, 5–15%.
• Subgaleal haemorrhage; predominantly vacuum, 3 to 6 in 1000.
• Intracranial haemorrhage; vacuum and forceps, 5 to 15 in 10 000.
• Cervical spine injury; mainly Kiellands rotational forceps, rare.
• Skull fracture; mainly forceps, rare.
• Facial nerve palsy; mainly forceps, rare.
• Fetal death; very rare.
62.
63. APPLICATION OF THE CUP:
• The cup is placed against the
fetal head nearer the occiput
(flexion point) with the “knob”
of the cup pointing towards the
occiput.
• Flexion or pivot point is an
imaginary site located
midsagittally about 6 cm from
the center of the anterior
fontanel or about 3 cm in front
of the posterior fontanel.
64. SUCTION
• A vacuum of 0.2 kg/cm2 is induced by the pump slowly, taking at least
2 minutes.
• A check is made using the fingers round the cup to ensure that no
cervical or vaginal tissue is trapped inside the cup.
• The pressure is gradually raised at the rate of 0.1 kg/cm2 per minute
until the effective vacuum of 0.8 kg/cm2 is achieved in about 10
minutes time.
• The scalp is sucked into the cup and an artificial caput succedaneum
is formed.
66. TRACTION
• Traction must be at right angle to the cup
• Traction should be synchronous with the uterine contractions
• Traction is released in between uterine contractions
• Traction should be made using one hand along the axis of curve of
Carus.
67. • Indicating the directions of
traction at different stations of
the fetal head.
• Traction over this flexion or pivot
point either by ventouse or
forceps promotes flexion and
presents smaller diameter to the
pelvis
68. • Operative vaginal delivery (forceps/ventouse) should be abandoned,
where there is no descent of the presenting part with each pull or
when delivery is not imminent after three pulls with correctly applied
instruments by an experienced operator.
• On no account, traction should exceed 30 minutes
69.
70. The relative merits of vacuum extraction and forceps have been
evaluated in a Cochrane systematic review of ten randomised
controlled trials, involving 2923 primiparous and multiparous women.
• More likely to fail delivery with the selected instrument
• More likely to be associated with cephalhaematoma
• More likely to be associated with retinal haemorrhage
• More likely to be associated with maternal worries about baby
71. The relative merits of vacuum extraction and forceps have been
evaluated in a Cochrane systematic review of ten randomised
controlled trials, involving 2923 primiparous and multiparous women.
• Less likely to be associated with significant maternal perineal and vaginal
trauma
• No more likely to be associated with delivery by caesarean section
• No more likely to be associated with low 5-minute apgar scores
• No more likely to be associated with the need for phototherapy