Forcep delivery

Contribution by students of Bachelors of Eastern Medicine and Surgery (BEMS) from Hamdard University, Pakistan.

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: Blade Shank Lock Handle Each blades has two curves Cephalic curve to shape of foetal head Pelvic curve to pelvic curvature .

4. 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

5. Types of Forceps:

6. TYPES OF FORCEP APPLICATION 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.

7. ACTION OF TRACTION Traction: is the main action. Rotation: in deep transverse arrest, persistent occipito -posterior and mento -posterior.

8. INDICATIONS OF FORCEP DELIVERY Prolonged 2 nd 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.

9. 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

10. FOETAL INDICATIONS Fetal distress Prolapsed pulsating cord Preterm delivery After coming head in breech delivery

11. 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.

12. PRE-REQUISITIES FOR FORCEPS APPLICATION Forewater rupture Favourable position and presentation: occipito anterior occipito posterior face presentation after coming head in breech

13. 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.

14. CONTRAINDICATIONS Fetal prematurity Known fetal dimineralizing diseases ( e.g osteogenesis imperfecta ) Unengaged head Unknown fetal position Malpresentation

15. 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

16. FETAL COMPLICATIONS Fracture of the skull Intracranial haemorrhage Facial nerve palsy Trauma to the eyes ,face, scalp.