Forceps Delivery

INDICATIONS

Maternal :
- Delay in the second stage of labour 9 poor maternal effort)
- condtions where short second stage of labour is desirable eg preeclampsia, heard disease, respiratory problem
- Maternal exhaustion

Fetal :
- fetal distress
- delivery of the after coming head in breach delivery

Prerequisites for Forceps Delivery

A - Adequate Analgesia, appropriate positioning(lithotomy position)
B - Bladder catheterization
C - Cervix fully dilated and membranes ruptured/counsel the patient
D - Determine the position, station and pelvic adequacy
E - Episiotomy / Equipment (check for matching pairs)

Procedure

F - forceps (phantom application)

- Lt blade , LT hand, maternal Lt side pencil grip & vertical insertion with Rt thumb directing blade

- Rt blade , RT hand, maternal Rt side pencil grip & vertical insertion with Lt thumb directing blade
...
- Lock blades

Check application:
Post fontanelle 1cm above the plane of the shanks
Sagittal suture lies in the midline of the shanks /perpindicular to the plane of the shanks
The operator can not place more than a fingertip between the fenestration of the blade & the fetal head on either side

G – Gentle traction : applied with contraction & maternal expulsive efforts

H – Handle elevated: traction in the axis of the birth canal do not elevate handle to early

I – Incision: consider episiotomy if laceration imminent

J – Jaw: remove forceps when jaw is reachable or delivery assured

COMPLICATIONS
Maternal
- trauma to soft tissue :3rd/4th degree, double the risk compared to ventouse
- bleeding from lacerations
- trauma to urethra & bladder or fistula
- Pain 17% ventouse 11%

Fetal- bruising & laceration to the face- Injury to the fetal scalp
- cephalohematoma 9% Vent 25%- retinal hemorrhage 30% Vent 50%
- skull fracture- permanent nerve damage / Facial nerve

Indications and Contraindications of Forceps instead of Ventouse
Indications
- Face presentations
- Bleeding from fetal blood sampling site
- after comming head of breach
- delivery before 34 weeks

contraindications to a vaginal assisted delivery
- head not fully engaged- cervix not fully dilated