Contribution by students of Bachelors of Eastern Medicine and Surgery (BEMS) from Hamdard University, Pakistan.

1. FORCEP DELIVERY Made by:
Ramsha Marwat

2. Definition:
 Obstetric forceps is a double-bladed metal
instrument used for extraction of foetal head.
 This instrument is applied to foetal head and
then the operative uses traction to extract the
foetus, typically during a contraction while
the mother is pushing.

3. Design of forcep:
Basically it consist of two crossing branches.
Each branch has four components:
1. Blade
2. Shank
3. Lock
4. Handle
Each blades has two curves
 Cephalic curve to shape of foetal head
 Pelvic curve to pelvic curvature.

5. CLASSIFICATION OF FORCEP DELIVERY
 Outlet = Wrigley’s
 Outlet & low forceps = Simpson/Elliot
 Mid forceps = Tucker Mclane
 Midforceps & rotation = Kielland
 After coming head in breech = Piper

7. Types of Forceps:

11. TYPES OF FORCEPAPPLICATION
 CEPHALIC APPLICATION:
 The forceps is applied on the sides of the foetal head in the mento-
vertical diameter so, injury of the fetal face, eyes and facial nerve
is avoided.
 PELVIC APPLICATION:
 The forceps is applied along the maternal pelvic wall irrespective
to the position of the head.it is easier for application but carries a
great risk of foetal injuries.
 CEPHALO-PELVIC APPLICATION:
 It is the ideal and possible application when the occiput is directly
anterior or in mento-anterior diameter position.

13. ACTION OF TRACTION
 Traction: is the main action.
 Rotation: in deep transverse arrest, persistent
occipito-posterior and mento-posterior.

14. INDICATIONS OF FORCEP DELIVERY
 Prolonged 2nd stage
 It is the prolongation for more than 1 hour in
primigravidae or 30 mins in multiparae. This may
be due to:
 Poor voluntary bearing down
 Large fetus
 Rigide perineum
 Malposition: persistent occipito posterior and
deep transverse arrest.

15. MATERNAL INDICATIONS
 Maternal distress are manifested by
 Exhaustion
 Pulse greater than 100 beats per min
 Temperature greater than 38 C
 Sign of dehydration
 Maternal diseases as:
 Heart disease
 Pulmonary TB
 Pre eclampsia and eclampsia

16. FOETAL INDICATIONS
 Fetal distress
 Prolapsed pulsating cord
 Preterm delivery
 After coming head in breech delivery

17. PRE-REQUISITIES FOR FORCEPS
APPLICATION
 Anesthesia: general ,epidural, spinal, pudental
block.
 Adequate pelvic outlet.
 Aseptic measures
 Bladder and bowel evacuation
 Contractions of the uterus should be present.
 Dilatation of the cervix should be fully.
 Engaged head.

18. PRE-REQUISITIES FOR FORCEPS
APPLICATION
 Forewater rupture
 Favourable position and presentation:
 occipito anterior
 occipito posterior
 face presentation
 after coming head in breech

19. MANAGEMENT:
 Re-assessment: the forcep is removed and the
patient is re-examined to detect the cause and
correct it if possible.
 Caesarean section: it is indicated in
uncorrectable causes as CPD and contracted
outlet.
 Exploration of the birth canal: for any injuries.

20. CONTRAINDICATIONS
 Fetal prematurity
 Known fetal dimineralizing diseases (e.g
osteogenesis imperfecta)
 Unengaged head
 Unknown fetal position
 Malpresentation

21. MATERNAL COMPLICATIONS
Complications of anesthesia
 Lacerations:
 extentions of the episiotomy
 perineal tear
 vaginal tear
 cervical lacerations
 bladder injury
 rupture uterus
 pelvic nerve injuries
 puerperal infections

22. FETAL COMPLICATIONS
 Fracture of the skull
 Intracranial haemorrhage
 Facial nerve palsy
 Trauma to the eyes ,face, scalp.