Instrumental
Delivery
Forceps Delivery
indications
A.
Indicated :
1. Anesthesia
2. Heart disease
3. Pulmonary disease
4. Fetal distress
5. After coming head
6. In cesarean section
B.
Selected :
1.
Poor cintractions
2.
Fatigue
3.
Op position
4.
Prevention of cystocele and
rectocele ?
5.
Prevention of hemorrohid?
Contraindications
• Extreme prematurity (< 34
weeks)
• Suspected bleeding disorder
• Macrosomia, suspected or USG
established
Prerequisitions for forceps
1.
2.
3.
4.
5.
6.
7.
8.
9.
Full dilatation
Engagement
Empty bladder
Known position (of the fetal
head)
Ruptured membranes
Adequate anesthesia
Episiotomy
R/O C.P.D
Skilled operator
Parts of Equipment
1.
2.
Cup size 40, 50, 60 mm.
Types of cup
•
•
•
•
3.
4.
5.
Malestorm
Bird
Siliastic (Mety-vac)
M-cup.
Vacuum tubing.
Traction chain.
Suction apparatus—which has capacity
to produce 0.8 kg/cm2 negative
suction @ 550-600 mm Hg.
6.
Traction force max @ 22.7 kg
required before detachment or
pop-off takes place. This is the
safetyend point.
7.
Application distance: is 3 cm from
post edge of anterior fontanelle
of fetal sclap till the anterior
outer edge of traction cup.
8.
Site of applications
a- Flexing median
b. Hexing paramedian
Result in
c. Deflexing median
Asyncilitism
d. Deflexing paramedian
Failure for
correct
traction
Parts of Forcep's
• Has two crossing blade branches
• Each branch blade has four components
1. The blade
2. Shank
3. Lock—English and/or sliding type
4. Handle
• Each blade has two curves
a. Cephalic-coniorms to shape of fetal
head
b. Pelvic-confoims to pelvic curvature
Common Types of Forceps in Use
1. Wringly's outlet forceps
2. Simpson's
3. Tucker-McIane
4. Kielland forceps
5. Piper's forceps
6. Hay's forceps
Classification of Forceps Delivery
(Instrumental Delivery) (ACOG 2000)
Procedure Criteria
Outlet forceps
1. Sclap visible and at
interoitus without
separating labia
2. Fetal skull at pelvic floor
3. Sagittal suture in AF dia or
LOA or ROA position
4. Fetal head is or at pelvic
perineum (leading pole)
5. Rotation needed does not
exceed 45°



Low forceps
• Leading point ^ +2 station and
not on pelvic floor
• Rotation is 45° or less. LOA/
ROA to occiput ant and/or
LOP/POP with occiput posterior
• Rotation is > 45°
Mid forceps
Station above +2 cm but head
is Engaged (Abdomen palpable
vertex is I/5th only)
High forceps
Not included in this classification
Function of Forceps

Used as traction, rotation or both,
by and large used as a tractor

Possible Max Force Used
Upto 60 kg max after which fetal
skull damage is assured. Generally
with forceps at elbow along side
body leads to force of 22-27 kgs
per tractor pull.
Preparation of Forcep Application
1.
2.
3.
4.
5.
6.
7.
Pudendal block or regional anesthesia
Lithotomy position
Bladder assured empty
Perineum cleaned and draped
Forceps are constructed outside as to
be applied
Precise knowledge of exact position of
fetal head either by suture direction or
by locating posterior ear
Application as for biparital or bi malar
position, is only safe application of
forceps.
Indications
A. Maternal
• Exhausation
• Poor/absent maternal expulsive efforts
• Need to avoid maternal expensive effort,
cardiac disease/CVA
• Lack of effort
B. Fetal
• Nonreassuring fetal CTG test
C. Prolonged 2nd stage
• Primi > 2 hr without regional anesthesia
• Multi > 1 hr anesthesia (for with RA addl hr)
• Desired selective shortening of 2nd stage
Prerequisites
A. Maternal
• Lithotomy position
• Reassurance
• Consent
• Adequate analgesia
• Empty bladder
• Adequate assessed pelvis.
B. Fetal
• Cephalic presentation
• Membranes ruptured
• Engaged fetal head
• Position of head-known
• Station +2
• Flexed attitude
• Moulding of head +1 only.
C. Others
• Cervix fully dilated
• No placenta praevia
• Experienced operator
• Ability to do less, with facilities
existing prtoi to attempting.
Indications

Maternal
• Heart disease
• Pulmonary injury or severe COFD
• Severe intrapartum infection
• Neurological conditions such as cord
injury or neuromuscular diseases
• Prolonged 2nd stage.

Fetal Indications
• Prolapse of umbilical cord
• Premature separation of placenta
• Non-assuring CTG tracing, persistant.

Others
•
Lack of maternal expulsive effort
•
Elective shortening of 2nd stage
(prophylactive) or social need.
Prerequisites
1.
2.
3.
4.
5.
6.
7.
8.
Vertex presentation or face with
chin out (mento-anterior)
Head must be engaged
Position of fetal head well known
Cervix fully dilated
Bladder completely empty
Membranes ruptured
No CPD assessed
Informed mother's consent.