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- 2. Forceps • F –Favourable head position and station • O – Open Os • R – Ruptured membranes • C – Contractions present and consent • E – Engaged head, Empty bladder • P – Pelvimetry • S - Stirrups, Lithotomy position
- 3. Introduction • Obstetric forcepsis a double bladed metal instrument used for extraction of fetal head. • This instrument is applied to fetal head and then operative uses traction to extract the fetus, typically during a contraction while the mother is pushing.
- 4. Definition • Obstetric Forcepsis a pair of instruments specially designed to assist the extraction of the fetal head and thereby accomplishing delivery of the fetus. • Forceps delivery is a means of extracting the fetus with the aid of obstetric forceps when it is advisable or impossible for the mother
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- 6. Classification of Forceps delivery Outlet= Wrigley’s Outlet & Low Forceps = Simpson/Elliot Mid forceps = Tucker Mclane Midforceps & Rotation = Kielland After coming head in breech = Piper
- 8. Classification of Forceps delivery •Outlet forceps – Scalp visible at the vulva without separating the labia. • Low forceps – Vertex at +2 Station • Midforceps – Head is engaged but leading part above +2 station. - Sagittal suture not in the AP plane of the mother.
- 9. Types of forcepsapplication • Cephalic application: The forceps is applied on the sides of the fetal head in the mentovertical diameter so, injury of the fetal face, eyes and facial nerve is avoided.
- 10. • Pelvic application: Theforceps 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 fetal injuries. • Cephalo-pelvic application: It is the ideal and possible application when the occiput is directly anterior or in mento-anterior diameter position.
- 12. Action of traction •Traction: is the main action • Rotation: in deep transverse arrest, persistent occipito-posterior and mento-posterior.
- 13. Indications 1. Prolonged 2ndstage 2. It is the prolongation for more than 1 hour in Primigravida or 30 minutes in Multipara. This may be due to: - Poor voluntary bearing down - Large fetus - Rigid perineum - Malposition: persistent occipito-posterior and deep transverse arrest.
- 14. Indication Maternal Fetal Maternal distressare 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. • Fetal distress • Prolapsed pulsating cord • Preterm delivery • After coming head in breech delivery
- 15. Pre-requisites 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 • Forewater rupture • Favourable position and presentation
- 16. Management • Re-assessment :the forceps 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.
- 17. Contraindications • Fetal prematurity •Known fetal dimineralizing diseases (e.g osteoporosis imperfecta) • Unengaged head • Unknown fetal position • Malpresentation
- 18. Complications Maternal Fetal • Extensionof the episiotomy • Perineal tear • Vaginal tear • Cervical lacerations • Bladder injury • Rupture uterus • Pelvic nerve injuries • Puerperal infections • Fracture of the skull • Intracranial hemorrhage • Facial nerve palsy • Trauma to the eyes, face, scalp