Presentation on Forceps delivery . ppt

forceps is a pair of instrument specially designed to assist delivery

1. Forceps DeliveryForceps Delivery

2. Forceps …
Obstetric Forceps is a pair of
instrument specially designed to
assist extraction of the fetal head
and thereby accomplishing the
delivery of fetus.

3. Who?? When????
Peter I & Peter II (Chamberlen family)

Around AD 1600

4. Components …
•The fenestrated blade
•Shank
•Lock
• Handle

5. The blade
 Pelvic curve

Cephalic curve

6. How to
Identify??

7. When articulated…….

8. When isolated….

9. Classification (ACOG-2000)

Type of procedureCriteria
Outlet forceps.
1.Scalp is visible at the introitus
without separating the labia
2.Fetal skull has reached the level
of the pelvic floor
3.Sagital suture is in direct
anterior posterior diameter or in
the right or left occipito anterior
or posterior position.
4.Fetal head is at or in the
perineum
5.Rotation is < 45 degrees

10. Contd....
Type of procedure Criteria
Low forceps

Leading point of the fetal
skull (station) is at +2 or more
but has not yet reached the
pelvic floor.
a)Rotation is less than or
equal to 45 degrees.
b)Rotation is > 45 degrees.

11. Contd....
Type of procedure Criteria
Mid forceps

High forceps
Fetal head is engaged. Head is
1/5 palpable per abdomen but
presenting part is above + 2
station

Head is not engaged. This type
is not included in
classification.

12. Varieties of
forceps !!!
Long curved forceps with/
without axis traction device
Short curved forceps/wrigley’s
Kielland’s forceps

13. Long curved forceps
Length = 37cm
Distance between the tip of the
blades = 2.5 cm
The widest diameter between the
blades = 9cm.

14. With axis traction device

15. Wrigley’s forceps
(short curved
forceps) Kielland’s forceps

16. Technique of forceps
delivery

17. Prerequisites
proper indication
fully dialated cervix
membranes must be ruptured
Presentation (vertex,
face/aftercoming head of breech)

18. No CPD
position of the head should be
ascertained
bladder and rectum should be empty
Analgesia should be satisfactory
Informed consent

19. F-O-R-C-E-P-S
•F – favourable head position and
station
•O – open Os( fully dialated )
•R – Ruptured membranes
•C – Contractions present and consent
•E - Empty bladder & bowel,Episiotomy
•P – Pelvimetry (CPD ruled out)
•S – Stirrups ,lithotomy position

20. Procedure
two ways of applying forceps
The cephalic method
The pelvic method

21. Functions ….

Traction - In primigravidae, the pull
required is about 20 kg and that in
multiparae about 13 kg.
Rotation of the head
A protective cage
Controlled delivery of the after-
coming head in breech
Used as a vectis in LSCS
Compression effect

22. Indications
Maternal Fetal Others
Inadequate
expulsive
efforts
Maternal
exhaustion
Non reassuring
fetal heart rate
Fetal distress
After coming
head of breech
Liquor-meconium
stained
Prolonged second
stage of
labour(nullipara
>2hr;multipara>1
hr)
To cut short the
second stage of
labour

23. Dangers of forceps
maternal
Immediate Remote

Injury
Nerve injury
Post partum haemorrhage
Anaesthetic complications
Puerperal sepsis and maternal
mortality
Painful Perineal scares scars
Dyspareunia
Genital prolapse
Urinary incontinence
Sphincter dysfunction

24. F
etal
Immediate Remote
 
Asphyxia
 
Facial bruising
 
Intra cranial hemmorrhage
 
Cephal hematoma
 
Facial palsy

Fracture of skull
Cerebral palsy

25. Bibliography
•Dutta D C.Text book of
Obstetrics.Caicutta:New central book
agency;2004
•Cunningham FG,Levono KJ,et al.Williams
Obstetrics.Newyork:Mc Graw Hill;2005
•Mudaliar AL,MenonM K.Clinical
Obstetrics.New Delhi:Orient longman Pvt
Ltd;2005