Forceps and Vaccum

Question 1

What are 3 types of midcavity forceps?

Answer 1

Simpsons forceps
Neville Barnes’ forceps
Kielland’s forceps

Question 2

What are 2 type of outlet forceps

Answer 2

Pipers forceps

Wrigley’s forceps

Question 3

Describe Simpsons forceps and its use

Answer 3

Blade - cephalic and pelvic curvature
Shank - long
Lock -
Used for traction

Question 4

Describe Neville Barnes’ forceps

Answer 4

Blade - cephalic and pelvic curature
Shank - long
Lock -
Used for traction and head after breech

Question 5

Describe Kielland’s forceps

Answer 5

Blade - cephalic curvature no/slight pelvic curvature
Shank - long
Lock - sliding lock
Used for traction and rotation especially in deep transverse arrest and asynclitism in lateral or posterior position

Question 6

Describe Pipers forceps

Answer 6

Blade - cephalic and pelvic curvature
Shank - long with marked curvature
Lock -
Used to control head after breech

Question 7

Describe Wrigley’s forceps

Answer 7

Blade - cephalic curvature and pelvic curvature
Shank - short
Lock - fixed / English lock
Used for Cesarean sections or when head is below level of ischial spines

Question 8

What are 3 maternal indications for forceps delivery?

Answer 8

1 - Maternal illness requiring short 2nd stage eg cardiac disease, pre-eclampsia and eclampsia
2 - Maternal distress
3 - Prolonged second stage or failure to progress in 2nd stage. 1hr in primigravid and 30mins in multigravid

Question 9

What are 3 fetal indications for forceps delivery?

Answer 9

1 - Fetal distress
2 - Prematurity
3 - Head after a breech presentation

Question 10

What are the conditions needed prior to forceps delivery?

Answer 10

F - Full dilation of cervix
O - outlet adequate
R - ruptured membranes / rectum empty
C - contractions good / catheterize bladder
E - engaged head / episiotomy
P - position known / paedeatrician present
S - suitable presentation

Question 11

What are 5 maternal complications of forceps delivery?

Answer 11

Perinea tears - usually in Kielland’s delivery
Vaginal tears
Cervical tears - if not fully dilated
Uterine rupture - if have cephalopelvic disportion
Damage to surrounding viscera like bladder and rectum e.g. Fistula formation

Question 12

What are 4 fetal complications of forceps delivery

Answer 12

Facial nerve palsies
Scalp injuries - lacerations and crush injuries
Cephalhaematoma
Intracranial haemorrhage

Question 13

What is the failure rate of forceps delivery vs vacuum

Answer 13

Forceps - 2-10%

Vacuum - 10-20%

Question 14

What are the 4 types of cups for vacuum extraction?

Answer 14

Silc cup - when easy delivery is expected
Bird anterior cup - metal cup for OA (head flexed)
Bird posterior cup - metal cup for OP (head deflexed)
Kiwi cup - hand held

Question 15

What is the procedure for a vacuum extraction?

Answer 15

Go through FORCEPS pneumonic except cervix could be 8cm dilated
Apply largest cup possible to vertex (3cm from post fontanelle)
Build up to 0.2kg/cm2 and do a digital exam to ensure no entrapment of vaginal or cervical tissue
Vacuum then build up to 0.8kg/cm2 over 1-2mins
Traction commenced with contractions and maternal effort
Apply counter traction with thumb and index finger to feel if the cup detaches and to ensure plane of traction is perpendicular to cup
Traction is downwards, horizontal then upwards

Question 16

What are 5 advantages of vacuum over forceps?

Answer 16

1 - less training and experience
2 - No risk of excessive traction
3 - Clear cut rules
4 - Rotation on fetus not there
5 - Causes less injury to the mother

Question 17

What are disadvantages of vacuum over foreps\

Answer 17

Cannot be used on premature babies or when mother cant assist the delivery with expulsive efforts
Needs more complex instruments 
More trauma to the baby
Higher failure rate
5-20% develop cephalhaematoma