obstetric & gynaecology

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