Obstetrics Book

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Forceps Assisted Delivery

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  1. See Also
    1. Vacuum Assisted Delivery
  2. Forceps Anatomy
    1. Two separable arms: right and left
      1. Shank
        1. Parallel
        2. Overlapping
      2. Arm Locks
        1. Sliding
        2. English (Scissors)
        3. French Lock (set screw)
      3. Handle
    2. Blade (Tow and heel)
      1. Blade Curves
        1. Pelvic curve: blades follow birth canal curve
        2. Cephalic curve: blades apply well to fetal head
      2. Blade Shape
        1. Fenestrated
        2. Semifenestrated
        3. Solid
  3. Definitions
    1. Station (See Fetal Descent)
      1. Level of fetal head to maternal ischial spines
    2. High Forceps (Kielland's Forceps)
      1. Vertex not engaged
      2. No longer used (historical reference only)
    3. Mid Forceps (Anderson's or Simpson's Forceps)
      1. Head engaged (above +2 station)
      2. Rarely used
    4. Low Forceps or Outlet Forceps (Wrigley's Forceps)
      1. Below +2 station
      2. Rotation <= 45 degrees
  4. Indications
    1. Maternal Distress
      1. Cardiac disease
      2. Pregnancy Induced Hypertension
      3. Chorioamnionitis
      4. Acute pulmonary edema
      5. Maternal exhaustion
    2. Fetal Distress
      1. Cord prolapse
      2. Abruptio Placentae
    3. Prolonged second stage of labor
      1. Inadequate contractions
      2. Ineffective maternal effort
      3. Malrotation of the fetal head (Occiput Posterior)
      4. Perineal rigidity
      5. Epidural Anesthesia
  5. Preparation
    1. Preparation for Assisted Delivery
    2. Preconditions
      1. Head engaged
      2. Vertex Presentation
      3. Head position known
      4. Complete Cervical dilation to 10 cm
      5. Rupture of Membranes
      6. No Cephalopelvic Disproportion
      7. Bladder empty
      8. Adequate anesthesia
  6. Technique
    1. Simpson Forceps commonly used forceps
    2. Forceps applied across ears to mandible region
    3. Apply forceps flat against head then rotate
    4. Posterior Fontanelle is 1 cm anterior to plane of shank
    5. Sagittal Suture bisects longitudinal axis
    6. Handle closes easily
    7. Traction to head until under symphysis pubis
    8. Rotate handle up
    9. Scalp visible at introitus
    10. Do not rotate >45 degrees
  7. Documentation: Operative Note Example
    1. Indication: Maternal exhaustion
    2. Instrument: Simpson forceps
    3. Operation: Outlet forceps
    4. Anesthesia: Local 2% Xylocaine
    5. Bladder: Via straight catheter
    6. Blood loss: <500cc
    7. Infant: Apgars of 8 & 9
    8. Maternal: Small Episiotomy Repaired with 2-0 Vicryl
  8. Complications
    1. Maternal complications
      1. Vaginal Lacerations or cervical Lacerations
      2. Postpartum Hemorrhage
      3. Maternal Infection
    2. Fetal complications: Birth Trauma
      1. Cephalohematoma
      2. Facial Nerve Palsy
      3. Depressed skull Fracture

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