Forceps delivery - Copy.pptx

sdfgfdgfjk

1. FORCEPS DELIVERY Pre pare d by- JOISY S JOY Lecturer Mai Khadija Institute of Nursing Sciences , Jodhpur.

2. Forceps delivery Obstetric forceps is a specially designed instrument to assist in extraction of fetal head thereby accomplishing delivery of the foetus . There are eight main requirements to be fulfilled before forceps application: Delivery must be mechanically feasible as demonstrated by engagement of the head, determination of level of presenting part and adequacy of maternal pelvis. Presenting part must be either vertex, face with anterior chin or after coming head in vaginal breech. The position of the head must be known. Uterine contractions must be present. Membranes must have ruptured. Cervix must be fully dilated. Anesthesia must be adequate (pudendal and local are acceptable for low forceps and epidural or spinal for Kielland's forceps). Bladder must be empty (if necessary, bladder can be drained by urinary catheterization prior to forceps delivery).

3. To extract the fetal head To shorten the second stage of labour To reduce maternal exhaustion To rotate the fetal head in case of occiput transverse, occiput posterior positions To assist in the delivery of after coming head of the breech 01 02 03 04 05 Purposes 06 To extract the fetal head during the cesarean section birth

4. Indications Maternal Inadequate expulsive efforts Malrotation of the head Maternal exhaustion Maternal medical conditions such as heart disease, hypertension, severe anaemia etc Prolonged second stage of labour Foetal Fetal distress Aftercoming fetal head of breech Low birth weight Postmaturity

5. Contraindications Face or brow presentation Cervix is not fully dilated Preterm less than 34 weeks or estimated fetal weight less than 2500 gram Suspected fetal coagulation disorder Fetal macrosomia

6. Parts of a forceps The instrument consists of two steel parts that cross each other like a pair of scissors and lock at the intersection. The lock maybe of a sliding type or a screw type. Each part consists of a handle, a lock, a shank and a blade. The blade is the curved portion applied to the sides of the fetal head. The blades of most forceps have a fenestrum, a large opening for window to enhance the grip on the fetal head. The blades usually consist of two curves; a cephalic curve which conforms to the shape of the head and a pelvic curve to follow the curve of the birth canal.

7. Axis traction forceps have a mechanism attached below, that permits the pulling to be done more directly in the axis of the birth canal. An axis traction handle also is available for use on standard forceps. The two blades of the forceps are designed as right and left. The left blade is introduced into the vagina on the client's left side, the right blade goes in on the right side.

8. Varieties of obstetric forceps

9. Classification of forceps application according to the station of the head Outlet forceps - 45 rotation or less required; applied when the scalp is visible at the introitus without spreading the labia. The skull has reached the pelvic floor, the sagittal suture is in the anteroposterior diameter or right or left anterior or posterior position and the fetal head is at the perineum. Low forceps - Rotation requiring more than 45 or less than 45 ; applied when the leading point of the skull is at the station +2 or more. Mid forceps - Applied when the head is engaged but the leading point of the skull is less than +2. Note: Under no circumstances should forceps be applied to an unengaged presenting part.

10. Preparation of mother Explain the procedure and get informed consent. Start physical preparation including skin preparation and enema. Start IV line. Empty the bladder (catheterize if needed).

11. Procedure After the decision is made to use forceps, select the type of instruments to be used. Position the mother in lithotomy. Wash hands and wear gloves. Drape the mother. Perform per vaginal examination. Check for the prerequisites F - favorable head position and station O - open os (fully dilated cervix) R - ruptured membranes C - contractions present and verbal or written consent E - engaged head, empty bladder P - pelvimetry, no major CPD S - stirrups, lithotomy position

12. 7. Infiltrate the perineum with Inj. Xylocaine . 8. Perform generous episiotomy. 9. Two or more fingers of one hand is introduced into the left side of the vagina. These fingers guide the left blade into place and at the same time protect the maternal soft parts (vagina and cervix) from injury. 10. The other hand is used to introduce the left blade of the forceps into the left side of the vagina, gently placing it between the fetus’ head and the fingers of the hand. 11. The same procedure is carried out on the right side. 12. Then the blades are articulated or attached together at the shank. 13. Traction is applied intermittently and not continuously. Between traction, the blades are partially disarticulated to release pressure on the fetal head. Instruct the woman to bear down during contraction and apply steady and intermittent traction simultaneously. Gently pull the head upward and forward towards the mother's abdomen.

13. 17. Remove the blades one after the other. 18. Administer parenteral oxytocin. Deliver the placenta by controlled cord traction. Suture the episiotomy layers. Document the name of the mother, age, obstetrical score, indication, types of forceps applied, date and time of procedure and complications if any.

14. Aftercare Assess the general condition of the mother Check the vital status Check for the contractility of the uterus Observe for bleeding Assess for the maternal and fetal complications 01 02 03 04 05

15. Complications Maternal Extension of episiotomy towards rectum or upward to the vault of vagina Vaginal lacerations Cervical tears especially when applied in the incompletely dilated cervix Bruising and trauma to the urethra PPH due to trauma, atonic uterus related to prolonged labour or effect of anaesthesia Shock due to blood loss, prolonged labour and dehydration Sepsis Foetal Asphyxia due to intracranial stress out of the prolonged compression Intracranial hemorrhage due to malapplication of the blades Cephalohematoma Facial palsy Abrasions on the soft tissue of the face and forehead by the forceps blade, severe bruising Skull fracture

16. THANK YOU