Professional Documents
Culture Documents
Forceps Delivery and Vacuum Extraction: Department of Obst. & Gynae. K.G. Medical University, Lucknow
Forceps Delivery and Vacuum Extraction: Department of Obst. & Gynae. K.G. Medical University, Lucknow
VACUUM EXTRACTION
Right and
left blade
VARIETIES OF LOCKS
French lock
English lock
German lock
Gliding lock
Pivot lock
VARIETIES OF OBSTETRIC FORCEPS
• CONVENTIONAL TRACTION • SHORT FORCEPS-
FORCEPS Wrigleys, Short Simpson
• LONG FORCEPS-Das
Simpson
• LONG FORCEPS with
AXIS TRACTION-
Milne Murray,
Haig Fergusen,
Nevelles Barnes
ELLIOTS FORCEPS
• OVERLAPPING SHANKS
WITH SHORTER CEPHALIC
CURVE
TARNIER FORCEPS (AXIS TRACTION DEVICE)
ROTATION FORCEPS. • Kielland, Moolgaokar,
Barton(for transverse
arrest in flat pelvis)
FORCEPS FOR SPECIAL
USE. • AFTER COMING HEAD
OF BREECH-Pipers.
• AT CAESARIAN SECTION-
Hale
PIPERS FORCEPS
PIPER FORCEPS(AFTER COMING HEAD OF BREECH)
NAEGELE FORCEPS (FORCEPS WITH SEPARATE PARELEL
SHANKS AND SLIGHTELY LONGER BLADES)
• The current classification of ACOG(2000,
2002) emphasizes the two most important
discriminators of risk for both mother and
infant are station and rotation.
• Station is measured in cm -5 to 0 to +5.
Deliveries are categorized as outlet, low, and
mid-pelvic procedures.
• High forceps in which instruments are applied
above 0 station have no place in
contemporary obstetrics.
CLASSIFICATION OF FORCEPS DELIVERY-
ACCORDING TO STATION AND ROTATION
OUTLET FORCEPS-
-Scalp is visible at the introitus without
separating the labia.
-Fetal scalp has reached pelvic floor.
-Saggital suture is in antero-posterior diameter
or right or left occiput anterior or posterior
position
-Fetal head is at or on perineum.
-Rotation does not exceed 45 degrees.
LOW FORCEPS
• Leading point of fetal skull is at station greater
or equal to +2cm and not on pelvic floor and
• Rotation is 45 degrees or less.
• Rotation is greater than 45 degrees.
• Inadequate progress
• Nulliparous women – Lack of continuing progress for 3
hours (total of active and passive second-stage labour)
with regional anaesthesia, or 2 hours without regional
anaesthesia
• Multiparous women – lack of continuing progress for 2
hours (total of active and passive second-stage labour)
• With regional anaesthesia, or 1 hour without regional
anaesthesia
• Maternal fatigue/exhaustion
PREREQUISITES FOR FORCEPS APPLICATION
1-Classical(obslete)
2-Wandering
3-Direct.
KIELLAND FORCEPS
Method of Application-(KIELLAND FORCEPS)
• Wandering method is popular-in this anterior blade is
applied first .Blade is inserted along side wall of pelvis
and then wandered by swinging it round the fetal face to
its anterior position.
• Posterior blade is inserted under guidance of right
hand ,forceps handles are depressed down and handle
tips are brought in alignment to correct asynclitism.
• The occiput is rotated anteriorly, slight upward
dislodgement of head may facilitate rotation, traction is
applied.
• DEEP MEDIOLATERAL EPISIOTOMY IS MANDATORY.
MATERNAL MORBIDITY FROM FORCEPS
• Operator inexperience
• Inability to assess fetal position
• High station(above 0 station)
• Suspicion of cephalopelvic disproportion
• Other presentations than vertex.
• Premature fetus(<34 weeks).
• Intact membranes.
Pre-requisites of the Procedure
• Procedure should be explained to the patient and
consent should be taken
• Emotional support and encouragement
• Lithotomy position.
• Bladder should be emptied.
• Antiseptic measures for the vagina, vulva and
perineum.
• Vaginal examination to check pelvic capacity, cervical
dilatation, presentation, position, station and degree
of flexion of the head and that the membranes are
ruptured.
Application of the cup
a) Fetal station
a) mid forceps
b) Low forceps
c) Inlet forceps
d) Outlet forceps
D ( OUTLET FORCEPS)
4)Prerequisites for forceps application include all
except which of the following:
a) Head is engaged
a) 30 week fetus
b) Fetal thrombocytopenia
a) Fetal distress
b) Face presentation
c) Transverse lie
d) Anemia
D ( Anemia)
7) The effective pressure to be achieved in vacuum
extraction is:
a) 0.1 kg/cm2
b) 0.8 kg/cm2
c) 0.4 kg/cm2
d) 1.2 kg/cm2
B ( 0.8 kg/cm2)
8) Forceps is applied in all the following except:
b)Face presentation
c) Occipitoposterior
d)Brow presentation
D ( Brow presentation)
9) Contraindication to ventouse delivery is all except:
a) Fetal coagulopathies
b) Extreme prematurity
b) Maternal parity