OSCE: OUTLET FORCEPS EXTRACTION

Criteria
 Scalp is visible at the introitus without separating the labia
 Fetal skull has reached the pelvic floor
 Fetal head is at or on perineum
 Saggital suture is in anteroposterior diameter or right/left occiput
anterior/posterior position
 Rotation does not exceed 45 degrees
Procedure
1. Address indication and obtain consent. Indication and plan must be clear and
well understood by the patient.
2. Assistance for the baby is available. Absence of contraindication of procedure.
3. Back up plan must be discussed with parents and the team.
4. Asepsis and antisepsis under adequate anesthesia.
5. Position the patient in dorsal lithotomy and apply drapes.
6. Bladder emptied via catheterization.
7. Determine position, station and pelvic adequacy. Internal examination done:
Give the (dilatation, presentation, station and position) Ex. cervix fully dilated,
vertex presentation, direct occiput anterior, station +4/5, with adequate uterine
contractions and assessment of maternal expulsive efforts. Think of possible
dystocia.
8. Select forceps based on the clinical requirements. Simpsons forceps were
checked for its functionality. Do phantom application.
9. Forceps are applied between contractions. Traction may be performed with or
without contraction.
10. Lubricate the blades. Left hand holding left blade, maternal left sides, pencil grip
and vertical insertion with the right thumb directing the blade. The assistant was
asked to hold the left blade once in place.
11. Right hand holding right blade, maternal right side, pencil grip and vertical
insertion with the left thumb directing the blade.
12. Forceps were locked and checked for proper application.
13. Proper application:

 Posterior fontanelle located midway between the blades, and 1 fingerbreadth

above the plane of the shanks with the lambdoid sutures equal distance from
the forceps blades

 Fenestration of blades barely felt. Equal amount of fenestration felt on each

side (with a solid blade no more than a fingertip should be able to be inserted
between the blade and the fetal head)
 Sagittal suture perpendicular to plane or shanks with occipital sutures 1 cm
above respective blades

1. Gentle intermittent horizontal traction is exerted following the curvature of the

sacrum until the perineum begins to bulge

2. Right Mediolateral episiotomy done when the vulva is distended by the

occiput

3. Gradual elevation of the forceps handle to promote extension of the head

4. When the jaw is visible forceps blades are removed one at a time

5. Delivery of the head and placenta.

6. Inspection of the cervix and vagina for any laceration. Do episiorrhapy.

7. Evacuation of blood clots done.

8. Rectal exam done.

9. Inspect the baby for fetal injury.

10. Document.