............FORCEPS DELIVERY............

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.

1. FORCEP DELIVERY Prepared by: Rashmi Goswami

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, L ithotomy position

3. Introduction Obstetric forceps is 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 Forceps is 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

5. Design of Forceps

6. Classification of Forceps delivery

7. 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.

8. Types of forceps application 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.

9. 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 fetal injuries. Cephalo - pelvic application: It is the ideal and possible application when the occiput is directly anterior or in mento -anterior diameter position.

10. Action of traction Traction : is the main action Rotation : in deep transverse arrest, persistent occipito -posterior and mento -posterior.

11. Indications 1. Prolonged 2 nd stage 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.

12. Indication Maternal Fetal 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. Fetal distress Prolapsed pulsating cord Preterm delivery After coming head in breech delivery

13. 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

14. 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.

15. Contraindications Fetal prematurity Known fetal dimineralizing diseases ( e.g osteoporosis imperfecta ) Unengaged head Unknown fetal position Malpresentation

16. Complications Maternal Fetal Extension of 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