Obstetric forceps and complication

For UG Class

1. Obstetric Forceps Dr. Sourav Chowdhury Senior Resident OBG, IQCMC

2. History ANKUSH – Vedic era WILLIAM CHAMBERLAIN – Fled from France in 1569 & practiced forceps delivery as a family secret in Southampton. This was kept as a family secret for over 100yrs and four generations . Hugh (son of Hugh)- who was highly educated and respected had patients from best families including Duke of Buckingham allowed the family secret to leak . Levret (1747)- introduced the pelvic curve Smellie (1751)- reinforced pelvic curve & introduced English lock and used in aftercoming head. Tarnier (1877)- introduced axis traction. Barton and Kielland - introduced the two specialized forceps.

3. CLASSIFICATION OF FORCEPS Classical

4. Classification of Forceps Newer classification as per A.C.O.G 1981(revised in 1991 ):- Criteria Low forceps Foetal scalp is visible without separating the vulva Foetal skull has reached the pelvic floor Sagital suture is in the A.P.diameter or in the Lt./Rt. Occiputo anterior/posterior position Rotation does not exceed 45degrees Outlet Forceps The leading point of the skull is 2cm or more below the ischeal spine but not on the pelvic floor Sagital suture is in the A.P.diameter or in the Lt./Rt. Occiputo anterior/posterior position Mid-Forceps The leading point of the skull is 2cm or less above the spine but head is engaged. Rotation not considered High Forceps Excluded

5. Parts of Forceps Blades Shank Lock Handle Screw

6. Functions Traction

7. Indications of Forceps

8. Contraindications Incompletely d ilated cervix Floating Head Obstructed labour due to contracted pelvis Malpresentation like brow, mentoanterior , face

9. Pre-requisites for Forceps delivery Maternal Fetal Others Cervix fully dilated Membrane ruptured Pelvis adequate Bladder empty Adequate maternal Anaesthesia & Analgesia Fetal head engaged Fetal head station exactly known Presence of neonatologist Aseptic technique Informed consent Experienced obstetrician Episiotomy

10. Types of Application of Forceps

11. Technique (of low & outlet forceps application )

12. Application of forceps

13. Forceps for After coming of Head Pipers Forceps Forceps to be applied when the occiput lies against the back of the symphysis Blades to be applied from below after raising the legs. Traction to be maintained in an arc, which follows the axis of the birth canal.

14. Maternal Complications Injury Nerve Injury Post-partum H aemorrrhage Anaesthesia Complications Puerperal Sepsis Maternal Morbidity

15. Fetal Complications Asphyxia Facial bruising, Intracranial Haemorrhage Cephalohaematome Facial Palsy Skull # & Cervical Spine Injury

16. Prophylactic Forceps This refers to delivery by forceps application to shorten second stage of labour when maternal and fetal complications are anticipated.

17. Trial Forceps IT’S A TENATIVE ATTEMPT OF FORCEPS DELIVERY IN A CASE OF SUSPECTED MIDPELVIC CONTRACTION WITH A PREAMBLE DECLARATION OF ABANDONING IT IN FAVOUR OF CAESAREAN SECTION IF MODERATE TRACTION FAILS TO OVERCOME RESISTANCE .

18. Failed Forceps When deliberate attempt in a vaginal delivery with forceps has failed to expedite the process, it is called failed forceps. Common causes:- Incompletely dilated cervix Unrotated occipito -posterior CPD Unrecognised malrotation Big baby Maternal BMI >30 Management :- To assess IV fluid RL and arrange BT Administer antibiotic Exclude Uterine rupture Abandon & Em -LSCS Laparotomy in Rupture

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