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Forcep delivery

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Contribution by students of Bachelors of Eastern Medicine and Surgery (BEMS) from Hamdard University, Pakistan.

Publicada em: Saúde e medicina
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Forcep delivery

  1. 1. FORCEP DELIVERY Made by: Ramsha Marwat
  2. 2. Definition:  Obstetric forceps is a double-bladed metal instrument used for extraction of foetal head.  This instrument is applied to foetal head and then the operative uses traction to extract the foetus, typically during a contraction while the mother is pushing.
  3. 3. Design of forcep: Basically it consist of two crossing branches. Each branch has four components: 1. Blade 2. Shank 3. Lock 4. Handle Each blades has two curves  Cephalic curve to shape of foetal head  Pelvic curve to pelvic curvature.
  4. 4. CLASSIFICATION OF FORCEP DELIVERY  Outlet = Wrigley’s  Outlet & low forceps = Simpson/Elliot  Mid forceps = Tucker Mclane  Midforceps & rotation = Kielland  After coming head in breech = Piper
  5. 5. Types of Forceps:
  6. 6. TYPES OF FORCEPAPPLICATION  CEPHALIC APPLICATION:  The forceps is applied on the sides of the foetal head in the mento- vertical diameter so, injury of the fetal face, eyes and facial nerve is avoided.  PELVIC APPLICATION:  The forceps is applied along the maternal pelvic wall irrespective to the position of the head.it is easier for application but carries a great risk of foetal injuries.  CEPHALO-PELVIC APPLICATION:  It is the ideal and possible application when the occiput is directly anterior or in mento-anterior diameter position.
  7. 7. ACTION OF TRACTION  Traction: is the main action.  Rotation: in deep transverse arrest, persistent occipito-posterior and mento-posterior.
  8. 8. INDICATIONS OF FORCEP DELIVERY  Prolonged 2nd stage  It is the prolongation for more than 1 hour in primigravidae or 30 mins in multiparae. This may be due to:  Poor voluntary bearing down  Large fetus  Rigide perineum  Malposition: persistent occipito posterior and deep transverse arrest.
  9. 9. MATERNAL INDICATIONS  Maternal distress are manifested by  Exhaustion  Pulse greater than 100 beats per min  Temperature greater than 38 C  Sign of dehydration  Maternal diseases as:  Heart disease  Pulmonary TB  Pre eclampsia and eclampsia
  10. 10. FOETAL INDICATIONS  Fetal distress  Prolapsed pulsating cord  Preterm delivery  After coming head in breech delivery
  11. 11. PRE-REQUISITIES FOR FORCEPS APPLICATION  Anesthesia: general ,epidural, spinal, pudental block.  Adequate pelvic outlet.  Aseptic measures  Bladder and bowel evacuation  Contractions of the uterus should be present.  Dilatation of the cervix should be fully.  Engaged head.
  12. 12. PRE-REQUISITIES FOR FORCEPS APPLICATION  Forewater rupture  Favourable position and presentation:  occipito anterior  occipito posterior  face presentation  after coming head in breech
  13. 13. MANAGEMENT:  Re-assessment: the forcep is removed and the patient is re-examined to detect the cause and correct it if possible.  Caesarean section: it is indicated in uncorrectable causes as CPD and contracted outlet.  Exploration of the birth canal: for any injuries.
  14. 14. CONTRAINDICATIONS  Fetal prematurity  Known fetal dimineralizing diseases (e.g osteogenesis imperfecta)  Unengaged head  Unknown fetal position  Malpresentation
  15. 15. MATERNAL COMPLICATIONS Complications of anesthesia  Lacerations:  extentions of the episiotomy  perineal tear  vaginal tear  cervical lacerations  bladder injury  rupture uterus  pelvic nerve injuries  puerperal infections
  16. 16. FETAL COMPLICATIONS  Fracture of the skull  Intracranial haemorrhage  Facial nerve palsy  Trauma to the eyes ,face, scalp.

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