OBSTETRIC FORCEPS

Question 1

These are metal instruments used to provide traction, rotation, or both to the fetal head.

Answer 1

OBSTETRIC FORCEPS

Question 2

Obstetrics forceps

• ________: used for traction only.
• ________: used for head rotation and traction.
• ________ used for the after-coming head of a vaginal breech baby.
• ________ used to deliver the head in occiput transverse position with a platypelloid pelvis.

Answer 2

Simpson

Kielland

Piper:

Barton:

Question 3

Use of forceps

• Outlet: fetal head is on the pelvic floor. Most ______ use is in this category.
• Low: fetal head is ____ but has not reached the pelvic floor.

• Mid: fetal head is below 0 station, but has not reached +2 station. This is seldom used
today.

• High: fetal head is unengaged, above 0 station. This is _______

Answer 3

forceps

below +2 station,

never appropriate in modern
obstetrics because of the risk to both mother and fetus

Question 4

MC Indication for forceps delivery

Answer 4

Prolonged second stage

Question 5

Indications for forceps delivery

Answer 5

Prolonged second stage
Category III EFM strip.
Avoid maternal pushing
Breech presentation

Question 6

Prerequesites for forceps delivery

Answer 6

• Clinically adequate pelvic dimensions
• Experienced operator
• Full cervical dilation
• Engaged fetal head
• Orientation of fetal head is certain

Question 7

These are cuplike instruments that are held against the fetal head with suction.

Traction is thus applied to the fetal scalp, which along with maternal pushing efforts, results in descent of the head leading to vaginal delivery.

The cups may be metal or plastic, rigid or soft.

Answer 7

VACUUM EXTRACTOR

Question 8

Advantages of vacuum extractor

Answer 8

1. Precise knowledge of fetal head position and attitude is not essential.
2. The vacuum extractor does not occupy space adjacent to the fetal head.
   3.Third- and fourth-degree lacerations are fewer.
3. Fetal head rotation occurs spontaneously at the station best suited to
   fetal head configuration and maternal pelvis

Question 9

Disadvantages of vacuum extractror

Answer 9

• Cup pop-offs. Excessive traction can lead to sudden decompression as the cup suction
is released.
• Scalp trauma. Scalp skin injury and lacerations are common.
• Subgaleal hemorrhage and intracranial bleeding are rare.
• Neonatal jaundice arises from scalp bleeding

Question 10

Indications for vacuum extraction

Answer 10

Indications Are Similar to Those of Forceps

Question 11

Pre-req for forceps

Answer 11

Prerequisites
• Clinically adequate pelvic dimension
• Experienced operator
• Full cervical dilation
• Engaged fetal head
• Gestational age is >34 weeks

Question 12

The overall U.S. cesarean section rate in 2011

was approximately ______, which includes both primary and repeat procedures

Answer 12

33%

Question 13

This incision is made in the noncontractile portion of the uterus and is the one most commonly used.

The bladder must be dissected off the lower
uterine segment. It has a low chance of uterine rupture in subsequent labor (0.5%).

Answer 13

Low segment transverse

Question 14

Low segment transverse advantages

Answer 14

are trial of labor in a subsequent pregnancy is safe; the risk of bleeding and adhesions is less.

Question 15

Low segment transverse disadvantages

Answer 15

Disadvantages are the fetus(es) must be in longitudinal lie; the lower segment
must be developed

Question 16

This incision is made in the contractile fundus of the uterus and is less commonly performed.

Technically it is easy to perform, and no bladder dissection is
needed

Answer 16

Classical

Question 17

Classical risk of rupture

Answer 17

Risk of uterine rupture both before labor as well as in subsequent labor is
significant (5%). Repeat cesarean should be scheduled before labor onset.

Question 18

Advantages of classical

Answer 18

are any fetus(es) regardless of intrauterine orientation can be delivered;
lower segment varicosities or myomas can be bypassed.

Question 19

Disadvantages of classical

Answer 19

are trial of labor in a subsequent pregnancy is unsafe; the risk of
bleeding and adhesions is higher

Question 20

Indications for Primary Cesarean Section

Answer 20

Cephalopelvic disproportion (CPD).
Fetal malpresentation
Category III EFM strip

Question 21

This is the most common indication for cesarean delivery.

This term literally means the pelvis is too small for the fetal head.

In actual
practice, it most commonly indicates failure of the adequate progress in labor, which
may be related to dysfunctional labor or suboptimal fetal head orientation.

Answer 21

CPD

Question 22

Fetal malpresentation. This refers most commonly to ________ but also
means any fetal orientation other than cephalic.

Answer 22

breech presentation,

Question 23

Vaginal Birth After Cesarean (VBAC) success rate

Answer 23

80%

Question 24

Criteria for trial of labor include
1
2
3

Answer 24

patient consent, nonrepetitive cesarean indication (e.g., breech, placenta previa), previous low segment transverse uterine incision, clinically adequate pelvis.

Question 25

This procedure consists of externally manipulating the gravid abdomen
without anesthesia to turn the fetus from transverse lie or breech presentation.

Answer 25

External Cephalic Version

Question 26

Cx of external cephalic version

Answer 26

Potential hazards are

umbilical cord compression or placental abruption requiring emergency cesarean section