47. Outlet forceps 48. Low forceps

Question 1

when are outlet forceps used ?

Answer 1

Scalp is visible at the introitus without separating the labia

Fetal skull has reached the level of the pelvic floor

Sagittal suture is in direct anteroposterior diameter or in the right or left occiput anterior or posterior position

„Fetal head is at the perineum

Rotation is < 45°

Question 2

when is low foreps used?

Answer 2

Leading point of the fetal skull (station) is at +2 cm or more but has not yet reached the pelvic floor. (a) Rotation is ≤ 45°
(b) Rotation is > 45°

Question 3

describe the forceps?

Answer 3

there are two blades named right or left in relation to maternal pelvis in which they lie when applied.

Each blade consists of the following parts: (1) Blade (2) shank (3) lock and (4) handle

The blade has got two curves
 Pelvic curve: Cephalic curve

Question 4

TYPES OF APPLICATION OF FORCEPS BLADES?

Answer 4

Cephalic application: The blades are applied along the sides of the head grasping the biparietal diameter in between the widest part of the blades. The long axis of the blades corresponds more or less to the occipitomental plane of the fetal head.
negligible compression effect on the cranium.

Pelvic application: When the blades of the forceps are applied on the lateral pelvic walls ignoring the position of the head
If the head remains unrotated, this type of application puts serious compression effect on the cranium and thus must be avoided.

Question 5

Prerequisites for Operative Vaginal Delivery forceps (or vacuum)

Answer 5

Fetal head engaged

„The cervix must be fully dilated

„The membranes must be ruptured

Fetal head position is exactly known - us
or triangle shaped posterior fontanelle and diamond shaped anterior one

Pelvis deemed adequate

Bladder must be emptied

Adequate maternal analgesia
-pudendal block

Episiotomy: It is usually done during traction when the perineum becomes bulged and thinned out by the advancing head.

contractions are adequate if not give oxytocin

Question 6

what are the general steps taken when using forceps?

Answer 6

Identification of the blades and their application
 Locking of the blades
 Traction
 Removal of the blades

Question 7

elaborate the identification of the blades and their application

Answer 7

ghosting practice holds the blade infront of the perinium as you would want it to go on baby’s head

the left blade applied first in ocipitoanterioir position

The operator places his or her back to the maternal right thigh and holds the handle between the fingers, as in holding a pencil.

The shank is held perpendicular to the floor same line as inguinal canal

the middle and index fingers are inserted into the vagina, and the thumb is applied to the heel of the blade

The force necessary to insert the blade is exerted by the thumb.

The left hand guides the handle in a wide arc until the blade is in place.

This blade is then held in place by an assistant. The right blade is then inserted in a similar manner,

Question 8

describe what should happen when we lock the blades ?

Answer 8

The 2 blades should be locked easily, if not this means that they were not correctly applied and should be removed and re-assess the position of the head

Question 9

how do we check if the blades are positioned correctly ?

Answer 9

1. The sagittal suture lies in the midline of the shanks.
2. The operator cannot place more than a finger tip between the fenestration of the blade and
   the foetal head.
3. The posterior fontanelle is not more than one finger- breadth above the plane of the shanks.

the lambdoid suture should be above the and equal distant from the blades

irm gripping of the head on the biparietal diameter – as judged by a few tentative pulls

Question 10

describe traction ?

Answer 10

only exert gentle traction which is intermittent with THE contractions
the loc

direction of traction always in the axis of the pelvis curve

operation depending upon the station of the head,

low forceps :
the direction of the pull is downwards
until the head comes to the perineum. Then pull is then directed horizontally straight towards the operator till the head is almost crowned.

in outlet forceps - upwards and forwards, towards the mother’s abdomen to deliver the head by extension.

pajot manurer - one hand pulling pulling in the direction they are extended
and the other hand pushes down on the shanks at 90 degrees

The 2 blades are unlocked between contractions to minimise the period of head compression.

Question 11

when do we remove the forceps ?

Answer 11

we remove the forceps when the jaw is visible

the right one comes of first

Question 12

indications for forceps ?

Answer 12

Inadequate expulsive efforts

„Maternal exhaustion (distress)

after coming head of breech - piper forceps

post maturity

Nonreassuring fetal heart rate— fetal distres

prolonged second stage of labour

cut short the second stage of labor as in severe preeclampsia, cardiac disease

Question 13

when is mid forceps used and give an example ?

Answer 13

Fetal head is engaged. Head is 1/5 palpable per abdomen but station is above +2 cm but not above the ischial spines

kielland

Question 14

what are the complications of forceps ?

Answer 14

Injury: Vaginal laceration or sulcus tear, cervical tear, extension of
episiotomy to involve the vaginal vault, complete perineal tear

„Nerve injury: femoral or lumbrosacral

„Postpartum hemorrhage

„Puerperal sepsis

=====
Asphyxia,

facial bruising,

intracranial hemorrhage (rupture of the great vein of Galen).

Cephalohematoma,

facial palsy,

skull fractures,

Question 15

contra for operative vag delivery ( FORCEPS AND VENTOUS)

Answer 15

(i) Unengaged fetal head
(ii) obvious CPD
(iii) patient’s refusal (iv) fetus having unacute bleeding diathesis (hemophilia)