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Assisted deliveries

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obstetric & gynaecology

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Assisted deliveries

  2. 2. LEARNING OUTCOMES • Describe the types of obstetric forceps. • State the indications, prerequisites, contraindications and describe the technique of obstetric forceps assisted delivery.
  3. 3. OBSTETRIC FORCEPS • A double-bladed metal instrument used for extraction of the fetal head • Parts: • Right and left branches • Articulation with locking or sliding mechanism • Handles connected to blades by shanks of variable lengths • 2 curves of the blade: cephalic & pelvic curves
  4. 4. OBSTETRIC FORCEPS • Blades: • grasp the fetus. • has a curve to fit around the fetal head. • oval or elliptical • fenestrated or solid • Many are curved in a plane 90° from the cephalic curve to fit the maternal pelvis (pelvic curve). • Shanks: • connect the blades to the handles • provide 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.
  5. 5. TYPES OF OBSTETRIC FORCEPS • Low cavity forceps (Wrigley’s) • Short and light • Also used at cesarean section • Mid-cavity non-rotational forceps (Neville-Barnes’, Haig Ferguson, Simpson’s) • 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 (Keilland’s) • Almost no pelvic curve • Allow rotation • Helps to correct malposition & asynclitism (fetus head not in line with mother’s pelvis) • Only attempted by experienced operator
  6. 6. FORCEPS ASSISTED DELIVERY : • Left blade inserted first before the right blade with accoucheur’s hand protecting vaginal wall from direct trauma • Blades lie parallel to axis of fetal head and between the fetal head & the pelvic wall • Articulates and locks the blades, then check the application before applying traction • Traction applied intermittently in concert with uterine contraction and maternal expulsive efforts • Axis of traction: • guided along ‘J’-shaped curve of pelvis • Directed vertical as head begin to crown
  8. 8. FORCEPS ASSISTED DELIVERY : • Maternal. • Maternal distress • Exhaustion • Undue prolongation of 2nd stage of labor • Medically significant conditions • Fetal. • Malposition of fetal head (occipito-transverse and occipito-posterior) • Fetal distress
  9. 9. FORCEPS ASSISTED DELIVERY : • 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.
  10. 10. F Fully dilated os (10cm) O Obstruction should be excluded (head ≤1/5 palpable) R Rupture of membrane C 1. Consent 2. Check instrument prior application 3. CPD excluded 4. Catheterize bladder E 1. Explain procedure 2. Epidural (or pudendal) analgesia 3. Examine genital tract (exclude genital tract trauma) P 1. Presentation & position identified 2. Pediatrician standby S 1. Station of presenting part ( not above ischial spine ) 2. Skillful operator and senior help available
  11. 11. FORCEPS ASSISTED DELIVERY : • 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
  12. 12. 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