PowerPoint Presentation

Izatty Lim0308188Forceps Assisted deliveries

Learning outcomes

Describe the types of obstetric forceps.

State the indications, prerequisites, contraindications and describe the technique of obstetric forceps assisted delivery.

obstetric forcepsA double-bladed metal instrument used for extraction of the fetal head

Parts:Right and left branches Articulation with locking or sliding mechanismHandles connected to blades by shanks of variable lengths2 curves of the blade: cephalic & pelvic curves

obstetric forceps4 major componentsBlades: grasp the fetus.has a curve to fit around the fetal head. oval or elliptical fenestrated or solidMany are curved in a plane 90 from the cephalic curve to fit the maternal pelvis (pelvic curve).

Shanks: connect the blades to the handlesprovide the length of the device. parallel or crossing.

Lock: articulation between the shanks.

Handles: to holds the device and applies traction to the fetal head.

types of obstetric forcepsElliot forcepsMore rounded curveUsed most often in women with at least 1 previous vaginal deliveryMuscle & ligaments of birth canal provide less resistance during 2nd and subsequent deliveries , allowing babys head to remain rounder

Simpson forcepsMore elongated curveUsed often in women having the 1st vaginal deliveryMolding: change in the babys head as it moves through the mothers pelvis ( more elongated)

Kielland forcepsAlmost no pelvic curveLess tractionMost common used for rotationSliding mechanismhelpful in asynclitism ( fetus head not in line with mothers pelvis )

types of obstetric forcepsLow cavity forceps (Wrigleys)Short and lightAlso used at cesarean section

Mid-cavity non-rotational forceps (Neville-Barnes, Haig Ferguson, Simpsons)Used when sagittal suture is in direct anteroposterior position (usually DOA)Malposition (DOP/DOL) can be corrected manually between contraction & the blades applied once head is in DOA position

Mid-cavity rotational forceps (Keillands)Almost no pelvic curveAllow rotationHelps to correct malposition & asynclitism (fetus head not in line with mothers pelvis)Only attempted by experienced operator

forceps assisted deliveryTechnique:Left blade inserted first before the right blade with accoucheurs hand protecting vaginal wall from direct traumaBlades lie parallel to axis of fetal head and between the fetal head & the pelvic wallArticulates and locks the blades, then check the application before applying tractionTraction applied intermittently in concert with uterine contraction and maternal expulsive effortsAxis of traction:guided along J-shaped curve of pelvis Directed vertical as head begin to crown

forceps assisted delivery

forceps assisted deliveryIndications:Maternal. Maternal distressExhaustionUndue prolongation of 2nd stage of laborMedically significant conditions

Fetal. Malposition of fetal head (occipito-transverse and occipito-posterior) Fetal distress

aortic valve disease with significant outflow obstruction or myasthenia gravis

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forceps assisted deliveryPrerequisites:Fully dilated cervix. Severe lacerations and hemorrhage may ensue if a rim of cervical tissue remains.

Head engaged. The extraction of a mature fetus with a "high" (unengaged) head usually is disastrous.

Vertex presentation or face presentation. Other presentations require wider-than-average pelvic diameters.

Membranes ruptured. Ensure a firm grasp of the forceps on the fetal head.

No cephalopelvic disproportion. If there is engagement, there must be no outlet contracture or gross sacral deformity.

Empty bladder and bowel. avoid laceration and fistula formation.

PREREQUISITESFFully dilated os (10cm)OObstruction should be excluded (head 1/5 palpable)RRupture of membraneCConsentCheck instrument prior application CPD excludedCatheterize bladderEExplain procedureEpidural (or pudendal) analgesia Examine genital tract (exclude genital tract trauma)PPresentation & position identifiedPediatrician standbySStation of presenting part ( not above ischial spine )Skillful operator and senior help available

forceps assisted deliveryContraindication:

Any contraindication to vaginal delivery

Refusal of the patient to consent to the procedure

Cervix not fully dilated/retracted

Inability to determine the presentation & fetal head position

Confirmed cephalopelvic disproportion

Absence of adequate anesthesia/analgesia

Inadequate facilities and support staff

Inexperienced operator

forceps assisted deliveryComplications of Forceps Delivery.Maternal.Lacerations of the vagina and cervix, predisposing to hemorrhage and infection.Rupture of the uterus.Injury to the bladder or rectum.

Fetal.Cephalohohematoma.Brain damage and intracranial hemorrhage.Skull fractures.Facial paralysis.Cord compression.

References Baker PN, Kenny LC(eds). Obstetrics by Ten Teachers. 19th ed. London: Hodder Arnold; 2011.

Collins S, Arulkumaran S, Hayes K, Jackson S, Impey L. Oxford Handbook of Obstetrics and Gynaecology. 3rd ed. Collins S, Arulkumaran S, Hayes K, editors. United Kingdom: Oxford University Press; 2013.

Medscape: Forceps Delivery [online]. 11th December 2013. Extracted on 17th April 2015.Available at: http://emedicine.medscape.com/article/263603-overview#a05

Healthline: Types of Forceps Used in Delivery [online]. 15th March 2012. Extracted on 17th April 2015.Available at: http://www.healthline.com/health/pregnancy/assisted-delivery-types-forceps#TypesofForceps1

Brookside Associates: Obstetric and Newborn Care [online]. 2007. extracted on 17th April 2015.Available at: http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_5_Section_1.htm