Forceps delivery

obstetrical condition

1. FORCEPS DELIVERY
JOHN BRITTO MARY.V,JOHN BRITTO MARY.V,
MSC NURSING 2MSC NURSING 2
NDND
YEAR, YEAR,
VINAYAKA MISSION’S COLLEGE VINAYAKA MISSION’S COLLEGE
OF NURSING, PUDUCHERRY.OF NURSING, PUDUCHERRY.

2. INTRODUCTION
FORCEPS DELIVERY MEANS USING OBSTETRIC FORCEPS DELIVERY MEANS USING OBSTETRIC
FORCEPS (A PAIR OF INSTRUMENTAL DESIGNED FORCEPS (A PAIR OF INSTRUMENTAL DESIGNED
TO EXTRACT FETAL HEAD) FOR DELIVERY WHEN TO EXTRACT FETAL HEAD) FOR DELIVERY WHEN
THE MOTHER IS UNABLE TO DELIVERY THE BABY THE MOTHER IS UNABLE TO DELIVERY THE BABY
BY HER OWN EFFORTS . IN OTHER WORDS, BY HER OWN EFFORTS . IN OTHER WORDS,
EXTRACTING FETAL HEAD WITH THE AID OF EXTRACTING FETAL HEAD WITH THE AID OF
SPECIALLY DESIGNED INSTRUMENT KNOWN AS SPECIALLY DESIGNED INSTRUMENT KNOWN AS
OBSTETRIC FORCEPS THEREBY ACCOMPLISHING OBSTETRIC FORCEPS THEREBY ACCOMPLISHING
DELIVERY OF THE FETUS WHEN MOTHER IS DELIVERY OF THE FETUS WHEN MOTHER IS
UNABLE TO COMPLETE THE DELIVERY BY HER UNABLE TO COMPLETE THE DELIVERY BY HER
EFFORTS.EFFORTS.
FORCEPS DELIVERY IS AN ASSISSTED BIRTH WITH FORCEPS DELIVERY IS AN ASSISSTED BIRTH WITH
THE AID OF FORCEPS. THESE ARE DESIGNED TO THE AID OF FORCEPS. THESE ARE DESIGNED TO
CRADLE THE BABYS HEAD AS TRACTION ON CRADLE THE BABYS HEAD AS TRACTION ON
HANDLES ASSISSTS THE BABY TO BE BORN HANDLES ASSISSTS THE BABY TO BE BORN

4. PURPOSE
TO ASSIST IN DELIVERY AFTER COMING TO ASSIST IN DELIVERY AFTER COMING
HEAD OF BREECH.HEAD OF BREECH.
TO TAKE OUT HEAD UP AND OUT OF PELVIS TO TAKE OUT HEAD UP AND OUT OF PELVIS
AT CAESAREAN SECTION.AT CAESAREAN SECTION.
TO ROTATE AND TAKE OUT OF HEAD IN AN TO ROTATE AND TAKE OUT OF HEAD IN AN
UNFAVOURABLE POSITION OF BABY IN UNFAVOURABLE POSITION OF BABY IN
VERTEX PRESENTATION.VERTEX PRESENTATION.
TO DELIVER BABY IN CASE OF FETAL TO DELIVER BABY IN CASE OF FETAL
DISTRESS AFTER FULFILLING THE DISTRESS AFTER FULFILLING THE
CONDITIONS FOR USE OF FORCEPS.CONDITIONS FOR USE OF FORCEPS.

5. INDICATIONS
FOLLOWING ARE THE INDICATIONS FOR USE OF FOLLOWING ARE THE INDICATIONS FOR USE OF
FORCEPS:FORCEPS:
MATERNALMATERNAL
FETALFETAL
MISCELLANEOUS / OTHERSMISCELLANEOUS / OTHERS
A)MATERNAL:A)MATERNAL:
- - MATERNAL HEART DISEASES: MATERNAL HEART DISEASES: MATERNAL MATERNAL
HEART DISEASES IS A CONDITION WHERE HEART DISEASES IS A CONDITION WHERE
PUSHING WOULD BE DETRIMENTAL TO MOTHER . PUSHING WOULD BE DETRIMENTAL TO MOTHER .
FOR EG, A MATERNAL HEART DISEASES OR A FOR EG, A MATERNAL HEART DISEASES OR A
VERY HIGH PRESSURE WHERE PUSHING THE VERY HIGH PRESSURE WHERE PUSHING THE
BABY CAN BE DETERIMENTAL TO MOTHER. BABY CAN BE DETERIMENTAL TO MOTHER.

6. - - MATERNAL EXHAUSTIONMATERNAL EXHAUSTION : IT IS A CONDITION : IT IS A CONDITION
WHEN THE MOTHER IS BEING EXHAUSTED BY WHEN THE MOTHER IS BEING EXHAUSTED BY
PUSHING EFFORTS FOR A LONGER TIME PERIOD PUSHING EFFORTS FOR A LONGER TIME PERIOD
AND UNABLE TO TAKE HER OWN EFFORTS TO AND UNABLE TO TAKE HER OWN EFFORTS TO
PUSH THE BABY OUT AND HEAD IS ON PERINEUM PUSH THE BABY OUT AND HEAD IS ON PERINEUM
FOR 20-30 MINUTES WITHOUT ADVANCEMENT.FOR 20-30 MINUTES WITHOUT ADVANCEMENT.
- - INADEQUATE EXPULSIVE EFFORTSINADEQUATE EXPULSIVE EFFORTS : WHEN THE : WHEN THE
MOTHER EXPULSIVE ACTION OF FETUS IS POOR MOTHER EXPULSIVE ACTION OF FETUS IS POOR
DUE TO UTERINE INERTIA, POOR BEARING DOWN DUE TO UTERINE INERTIA, POOR BEARING DOWN
EFFORTS, USE OF REGIONAL BLOCKS, EFFORTS, USE OF REGIONAL BLOCKS,
PSYCHIATRIC DISRUBANCES OR PARALEGIA.PSYCHIATRIC DISRUBANCES OR PARALEGIA.
- - PRE-ECLAMSIA/ECLAMPSIAPRE-ECLAMSIA/ECLAMPSIA : MOTHER HAS POOR : MOTHER HAS POOR
EXPULSIVE EFFORTS DUE TO DRUGS RECIVED EXPULSIVE EFFORTS DUE TO DRUGS RECIVED
SUCH AS MAGNESIUM SULPHATE , DIAZAPEM, SUCH AS MAGNESIUM SULPHATE , DIAZAPEM,
DILANTIN.DILANTIN.

7. B) FETAL INDICATIONS:B) FETAL INDICATIONS:
-FETAL DISTRESSFETAL DISTRESS
-AFTER COMING HEAD OF BREECHAFTER COMING HEAD OF BREECH
-CORD PROLAPSECORD PROLAPSE
-LOW BIRTH WEIGHT BABYLOW BIRTH WEIGHT BABY
-POST MATURITYPOST MATURITY
C) MISCELLANEOUS:C) MISCELLANEOUS:
-PROLONGED SECOND STAGE OF LBOUR i.e IN PROLONGED SECOND STAGE OF LBOUR i.e IN
NULLIPARA – MORE THAN 2 HOURS AND MORE NULLIPARA – MORE THAN 2 HOURS AND MORE
THAN 1 HOURS IN MULTIPARA.THAN 1 HOURS IN MULTIPARA.
-TO REDUCE THE TIME FOR SECOND STAGE OF TO REDUCE THE TIME FOR SECOND STAGE OF
LABOUR.LABOUR.
-SEVERE ECLAMPSIASEVERE ECLAMPSIA
-HEART DISASES OF MOTHERHEART DISASES OF MOTHER
-POST CEASERIAN PREGNANCYPOST CEASERIAN PREGNANCY

8. TYPES OF FORCEPS USED
DEPENDING ON HOW FOR THE BABYS DEPENDING ON HOW FOR THE BABYS
HEAD HAS DECENDED DOWN THE WOMENS HEAD HAS DECENDED DOWN THE WOMENS
BIRTH CANAL AND POSITION OF THE BABYS BIRTH CANAL AND POSITION OF THE BABYS
HEAD FORCEPS HAVE BEEN CLASSIFIED HEAD FORCEPS HAVE BEEN CLASSIFIED
INTO FOLLOWING TYPES:INTO FOLLOWING TYPES:
HIGH FORCEPS HIGH FORCEPS
MID FORCEPSMID FORCEPS
LOW FORCEPSLOW FORCEPS
ROTATIONA FORCEPSROTATIONA FORCEPS
NON ROTATIONAL FORCEPSNON ROTATIONAL FORCEPS

10. HIGH FORCEPS
HIGH FORCEPS ARE USED WHEN HEAD IS NOT HIGH FORCEPS ARE USED WHEN HEAD IS NOT
ENGAGED. IT MEANS HEAD OF BABY IS IN LOWER ENGAGED. IT MEANS HEAD OF BABY IS IN LOWER
SECTION OF UTERUS AND IS DELIVERED WITH SECTION OF UTERUS AND IS DELIVERED WITH
HIGH FORCEPS i.e, FORCEPS NEED TO BE PLACED HIGH FORCEPS i.e, FORCEPS NEED TO BE PLACED
FURTHER UP THE VAGINA , INSIDE THE UTERUS. FURTHER UP THE VAGINA , INSIDE THE UTERUS.
THIS PRACTISE IS CONSIDERED TOO RISKY AS IT THIS PRACTISE IS CONSIDERED TOO RISKY AS IT
CAN LEAD TO INJURY TO WOMEN OR BABY. SO CAN LEAD TO INJURY TO WOMEN OR BABY. SO
THESE FORCEPS ARE NOT REQUIRED TO BE THESE FORCEPS ARE NOT REQUIRED TO BE
USED. IT IS BETTER TO HAVE CASEAREAN USED. IT IS BETTER TO HAVE CASEAREAN
SECTION INSPITE OF USING HIGH FORCEPS FOR SECTION INSPITE OF USING HIGH FORCEPS FOR
DELIVERY. DELIVERY.

11. MID FORCEPS
MID FORCEPS ARE USED , WHEN MID FORCEPS ARE USED , WHEN
HEAD IS ENGAGED AND PRESENTING HEAD IS ENGAGED AND PRESENTING
PART IS ABOVE +2 STATION. THE PART IS ABOVE +2 STATION. THE
COMMONLY USED FORCEPS ARE:COMMONLY USED FORCEPS ARE:
-NEVILLE BARNES (NB)NEVILLE BARNES (NB)
-HAIG FERGUSON (HF)HAIG FERGUSON (HF)

12. LOW FORCEPS
THESE ARE MOST COMMONLY USED THESE ARE MOST COMMONLY USED
FORCEPS. THESE FORCEPS ARE USED FORCEPS. THESE FORCEPS ARE USED
WHEN THE BABYS HEAD IS BELOW WHEN THE BABYS HEAD IS BELOW
STATION +2 , WHICH IS FAIRLY LOW IN STATION +2 , WHICH IS FAIRLY LOW IN
VAGINAL CANAL. IT MEANS LEADING POINT VAGINAL CANAL. IT MEANS LEADING POINT
OF FETAL SKULL IS +2 OR MORE BUT HAS OF FETAL SKULL IS +2 OR MORE BUT HAS
NOT YET REACHED THE PELVIC FLOOR. NOT YET REACHED THE PELVIC FLOOR.
LOW FORCEPS ARE USUALLY ABLE TO LOW FORCEPS ARE USUALLY ABLE TO
SUCCESSFULLY DELIVER THE BABY. THE SUCCESSFULLY DELIVER THE BABY. THE
MOST COMMENLY USED LOW FORCEPS IS: MOST COMMENLY USED LOW FORCEPS IS:
SIMPSONS FORCEPS. SIMPSONS FORCEPS.

13. OUTLET FORCEPS
OUTLET FORCEPS ARE USED , WHEN THE BABYS HEAD CAN OUTLET FORCEPS ARE USED , WHEN THE BABYS HEAD CAN
BE EASILY SEEN AT THE OPENING OF THE WOMANS VAGINA , BE EASILY SEEN AT THE OPENING OF THE WOMANS VAGINA ,
BUT THE BABYS HEAD IS NOT EMEMRGING ANY FURTHR. IT BUT THE BABYS HEAD IS NOT EMEMRGING ANY FURTHR. IT
MEANS OUTLET FORCEPS ARE APPLIED WHEN: MEANS OUTLET FORCEPS ARE APPLIED WHEN:
-SCALP IS VISIBLE AT THE INTROITUS WITHOUT SEPERATING SCALP IS VISIBLE AT THE INTROITUS WITHOUT SEPERATING
THE LABIA .THE LABIA .
-FETAL SKULL HAS REACHED THE LEVEL OF THE PELVIC FETAL SKULL HAS REACHED THE LEVEL OF THE PELVIC
FLOOR .FLOOR .
-SAGITTAL SUTURE IS IN DIRECT ANTERIOR POSTERIOR SAGITTAL SUTURE IS IN DIRECT ANTERIOR POSTERIOR
DIAMETRE OR IN THE RIGHT OR LEFT OCCIPUT ANTERIOR DIAMETRE OR IN THE RIGHT OR LEFT OCCIPUT ANTERIOR
OR POSTERIOR POSITION.OR POSTERIOR POSITION.
-FETAL HEAD IS AT OR AN PERINUM.FETAL HEAD IS AT OR AN PERINUM.
-ROTATION IS < 45 DEGREES.ROTATION IS < 45 DEGREES.
-MOST COMMOMLY USED OUTLET FORCEPS ARE;MOST COMMOMLY USED OUTLET FORCEPS ARE;
-WRINGLEYS FORCEPSWRINGLEYS FORCEPS

14. ROTATIONAL FORCEPS
ALONG WITH ENGAGEMENT OF HEAD OF BABY, ALONG WITH ENGAGEMENT OF HEAD OF BABY,
OTHER ASPECTS ARE CONSIDERED WHILE OTHER ASPECTS ARE CONSIDERED WHILE
SELECTING THE FORCEPS i.e, WHEN THE BABY SELECTING THE FORCEPS i.e, WHEN THE BABY
NEEDS TO BE TURNED FROM POSTERIOR NEEDS TO BE TURNED FROM POSTERIOR
POSITION. AS A BABY IN A POSTERIOR POSITION POSITION. AS A BABY IN A POSTERIOR POSITION
PREVENT THE BABY FROM DESCENDING DOWN PREVENT THE BABY FROM DESCENDING DOWN
THE BIRTH CANAL. ROTATIONAL FORCEPS THE BIRTH CANAL. ROTATIONAL FORCEPS
COMMONLY USED AS COMMONLY USED AS
- - KIELLANDS FORCEPS : KIELLANDS FORCEPS : THIS FORCEPS ARE USED THIS FORCEPS ARE USED
TO TURN THE BABY INTO A MORE FAVOURABLE TO TURN THE BABY INTO A MORE FAVOURABLE
ANTERIOR POSITION AND THEN TRACTION IS ANTERIOR POSITION AND THEN TRACTION IS
USED WITH SAME FORCEPS TO DELVER THE BABYUSED WITH SAME FORCEPS TO DELVER THE BABY

15. NON ROTATIONAL FORCEPS
MOST OF MID, LOW, AND OUTLET MOST OF MID, LOW, AND OUTLET
FORCEPS ARE NOT ROTATIONAL FORCEPS ARE NOT ROTATIONAL
TYPE. THEY ARE USED TO BRING THE TYPE. THEY ARE USED TO BRING THE
BABY DOWN. THE BIRTH CANAL BABY DOWN. THE BIRTH CANAL
WITHOUT CHANGING THE POSITION WITHOUT CHANGING THE POSITION
OF THE BABYS HEAD.OF THE BABYS HEAD.

16. CRITERIA TO BE FULLFILLED
BEFORE APPLICATIONS
FORCEPS
-THE CERVIX MUST BE FULLY DILATED.THE CERVIX MUST BE FULLY DILATED.
-THE MEMBRANES MUST BE RUPTUREDTHE MEMBRANES MUST BE RUPTURED
-THE FETAL HEAD MUST BE ENGAGEDTHE FETAL HEAD MUST BE ENGAGED
-THE FETAL HEAD AND POSITION MUST BE KOWN THE FETAL HEAD AND POSITION MUST BE KOWN
WITH CERTANITY WITH CERTANITY
-THERE SHOULD NOT BE MAJOR C.P.D BY CLINICAL THERE SHOULD NOT BE MAJOR C.P.D BY CLINICAL
PELVIMETRYPELVIMETRY
-BLADDER SHOULD BE EMPTIED BLADDER SHOULD BE EMPTIED
-ADEQUATE ANALGESIA HAS BEEN GIVEN TO ADEQUATE ANALGESIA HAS BEEN GIVEN TO
MOTHER.MOTHER.
-NEED TO BE DONE BY EXPERIENCED PERSON.NEED TO BE DONE BY EXPERIENCED PERSON.

17. COMPLICATIONS
MATERNALMATERNAL
FETALFETAL

18. MATERNAL
-INJURY:INJURY:
-VAGINAL LCERATIONSVAGINAL LCERATIONS
-CERVICAL TEARCERVICAL TEAR
-EXTENSION OF EPISIOTOMYEXTENSION OF EPISIOTOMY
-COMPLETE PERINEAL TEARCOMPLETE PERINEAL TEAR
-L2,3,4, INJURYL2,3,4, INJURY

19. POST PATRUM HAEMORRHAGEPOST PATRUM HAEMORRHAGE
-TRAUMATICTRAUMATIC
-ATONIC UTERUSATONIC UTERUS
-BOTH- TRAUMATIC & ATONIC UTERUSBOTH- TRAUMATIC & ATONIC UTERUS
IT CAN RESULT IN SHOCK.IT CAN RESULT IN SHOCK.

20. FETAL
- FASCIAL BRUSING - FASCIAL BRUSING
- INTRCRANIAL HAEMORRHAGE- INTRCRANIAL HAEMORRHAGE
- FASCIAL PALSY- FASCIAL PALSY
- CEPHALOHEMATOMA- CEPHALOHEMATOMA
- CERVICAL SPINE INJURY- CERVICAL SPINE INJURY
- ASPHYXIA- ASPHYXIA

21. THANK YOU