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Instrumental delivery

Prepared by:

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
19th April, 2007

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Obstetric forceps

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Varieties of forceps

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Varieties of forceps

1. Long curved

2. Long curved with


axis traction device

3. Wrigley’s

4. Kielland’s

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Type of forceps application
1. High forceps

2. Mid cavity forceps

3. Low forceps: Head station +2 or


more but not at pelvic floor

4. Outlet forceps:
– Fetal head visible at pelvic floor
– Position: DOA,LOP,ROP
– Crowning

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Pre-requisites of forceps application
1. Head Engaged

2. Cx Dilated

3. Membrane ruptured

4. Station and position


identifiable

5. No CPD

6. Empty bladder
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Indication of forceps application

1. Prolonged 2nd stage

2. Maternal distress

3. To decrease maternal effort:


– Cardiac disease
– Eclampsia
– Cerebrovascular disease

4. Fetal distress

5. After coming head of breech

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Identifying blade: Rt. & Lt.

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Apply left blade 1st and hold it in position

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Apply right blade

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Lock both blades together

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Direction of pull on low forceps
application
1. Downward and backward
until head comes to perineum

2. Forward towards operator to


let head to crown

3. Upward and forward towards


mother’s abdomen

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Pull Downward  Anteriorly  Upward

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Complication

• Genital tract injury

• PPH

• Fetal injury:
– Facial bruising
– Facial nerve injury
– Cephalhematoma
– Skull fracture

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Vacuum extraction

Contraindication: Pre-requisites:
• Non-vertex presentation: • Engaged head
– Face
– Brow
– Breech • Membrane ruptured

• Preterm <34weeks • Empty bladder

• No bony resistance
below head
• Cx >6-8cm

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Mnemonic for Vacuum Extraction

A Ask for help, Address the patient, and is Anesthesia


needed.

B  Bladder empty.

C  Cervix must be completely dilated.

D  Determine position

E  Equipment and Extractor ready.

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F  Apply the cup over the sagittal suture and in relation
to the posterior Fontanelle.

G  Gentle traction in the proper axis.

H  Halt traction when the contraction is over; Halt the


procedure if you have had disengagement of the cup
three times, have had no progress in three consecutive
pulls or three "pop-offs.“

I  Evaluate for Incision (episiotomy) when the head is


being delivered.

J Remove the cup after the Jaw is delivered.

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Vacuum Devices

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Vacuum extractor

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Silicon cup

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Plastic cups
Disposable Plastic Cup(DPC)(Mityvac device)

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Metal cup

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Rigid Metal cups
(Also k/a
Malmstrom cup)
Parts

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Cup applied to scalp

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Traction on vacuum cup

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Head rotates itself on traction

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Artificial caput formation

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Cephalic Hematoma

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Complication

1. Laceration of cervix and


vaginal wall

2. Sloughing of scalp

3. Cephalhematoma

4. Subaponeurotic
bleeding

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