3. The Obstetric Forceps
• Seventeenth century
secret for three
generations of
Chamberlen family
4. The Obstetric Forceps
• Curved blade - Cephalic curve for fetal head
- solid or fenestrated
• The Shank - straight between blade & lock
• The lock or joint – Double slot / sliding
• The handle - Finger grip
5.
6. The Obstetric Forceps
Modes of action :
• Traction
• Compression
• Lateral lever action
• Improves uterine contractions
7. The Obstetric Forceps
Indications for the use of forceps:
• Maternal distress
• Fetal distress
• Prolongation of the second stage
• Prophylactic forceps
8. The Obstetric Forceps
Maternal distress (exhaustion) late in labour
• Loss of morale
• Failure to co-operate with instructions of the
attendants
• Hysterical outbursts
• Rising temperature & pulse rate
• Signs of ketosis/ shock due to prolonged
physical efforts, starvation and dehydration
10. The Obstetric Forceps
Prolongation of the second stage:
• More than 2 hours in primipara without
analgesia
• More than 3 hours with analgesia
• More than 1 hour in multipara
11. The Obstetric Forceps
To cut short the second stage:
• Heart disease class III or IV
• Severe anaemia
• Severe asthma
• Hypertensive crisis, Eclampsia
• Cerebrovascular disease- malformations
• Myaesthenia Gravis
• Spinal cord injury
12. The Obstetric Forceps
Prerequisites- conditions to be fulfilled
• Suitable presentation- fetal head
vertex OA or OP
Face
Aftercoming head of breech
• Engaged fetal head
• Cervix fully dilated and effaced
• Adequate pelvic outlet
13. The Obstetric Forceps
Prerequisites continued:
• The uterus contracting & relaxing
• The bladder must be empty
• Bowel evacuated
• Membranes ruptured
• Informed consent with risks explained
• Proper anaesthesia & analgesia
14. The Obstetric Forceps
Forceps Applications :
• Cephalic-
Blades lie along the sides of fetal head
Long axis of blades ‖ occipitomental dia.
BPD occupies widest interval between.
Secure & safe grip
Minimum compression force
15. The Obstetric Forceps
Applications contd :
• Pelvic application:
Along the sides of the pelvis
Insecure grip
Injurious pressure on fetal head
Easier to apply
Safest application : Cephalic & pelvic coinside
‘OUTLET FORCEPS’
17. Type of Forceps Delivery
• Outlet forceps
– Scalp visible at introitus without separating labia
– Fetal skull reached pelvic floor & head at/on perineum
– Sagittal suture in AP diameter or LOA, ROA, or posterior position
– rotation does not exceed 45º
• Low forceps
– Leading point of fetal skull at >= +2, not on pelvic floor
– Rotation 45º or less (LOA/ROA to OA, or LOP/ROP to OP); or rotation
greater than 45º.
• Midforceps
– Above +2 cm but head engaged
• High forceps
– Head not engaged; not included in ACOG classification
– Not recommended
18. The Forceps Operation
• Careful aseptic preparations
Hair clipped short, skin washed, dried &
painted with antiseptic
• Operator: prepare hands & arms. Put on cap,
mask, gown & gloves
• Confirm all the prerequisites
• Position- Dorsal lithotomy, thighs flexed &
abducted, supported by stirrups or held by
assistants.
20. The Forceps Operation
Step II
Right blade in right hand in right side of pelvis
Locking the blades- should be easy.
Difficulty in locking & adjustment- suggests
faulty position of the head.
21. Forceps-Assisted Vaginal Delivery
• Identify & apply blades
– Place instrument in
front of pelvis with tip
pointing up & pelvic
curve forward
– Apply left blade, guided
by right hand, then right
blade with left hand
• Lock blades
– Should articulate with
ease
22. FAVD
• Check for correct application
– Sagittal suture in midline of shanks
– Cannot place more than one fingertip between
blade and fetal head
• Apply traction
– Steady and intermittent
– Downward and then upward
– Remove blades as fetus crowns
23.
24. The Forceps Operation
Extraction of the head:
• Extract the head slowly.
• Pull during ut contractions & to pause during
intervals
• To separate the handles slightly without
unlocking them.
• Direct traction in the axis of pelvis.
Outlet forceps- Downwards then forwards.
26. The Forceps Operation
• Trial of forceps
Uncertainity about achieving a safe vaginal delivery.
marked caput and moulding
prolonged labor with second stage dystocia
suspected macrosomia
• Failed forceps
Unsuccessful attempt to deliver with forceps
-unrotated occipitoposterior
-incompletely dilated cervix
-disproportion
- contraction ring
30. Indications
MATERNAL
• Exhaustion
• Prolonged second stage
• Cardiac / pulmonary disease
FETAL
• Failure of the fetal head to rotate
• Fetal distress
• Should not be used for preterm, face presentation or
breech
31. MNEMONIC
• A – Anesthesia adequate
appropriate positioning & access
• B – Bladder cathterization
• C – Cervix fully dilated / membranes
ruptured
• D – Determine position, station, pelvic
adequacy
33. • F – Fontanelle position the cup over the
posterior fontanelle
-ve pressure ↑ 10 cm H2O initially &
between contraction
sweep finger around cup to clear maternal
tissue
↑ pressure to 60 cm H2O with the next
contraction
34. • G – Gentle traction pull with contractions
traction in the axis of the birth canal
ask the mother to push during contraction
35. • H – Halt halt traction if no progress with
three traction aided contractions
vacuum pops off three times
pulling for 30 min without significant
progress
36. • I – Incision consider episiotomy if
laceration imminent
• J – Jaw remove vacuum when jaw is
reachable or delivery assured
40. Complications
• Vacuum –assisted delivery is less traumatic to the
mother & fetus than forceps
• Ventouse should be the instrument of choice
Maternal Vaginal laceration due to entrapment
of vaginal mucosa between suction cup & fetal
head