Forceps delivery is a method of extracting the fetus using obstetric forceps when the mother cannot complete the delivery on her own.
Forceps can also assist breech deliveries and caesarean sections.
A pair of instruments is used for the vaginal extraction of the fetal head, facilitating delivery.
Indications
Maternal Indications
Prophylactic Use: To shorten the second stage of labor in conditions threatening the mother or fetus that can be relieved by delivery.
Preeclampsia and eclampsia
Post-caesarean pregnancy
Heart disease
Hypertension
Neurological disorders where voluntary effort is contraindicated or impossible
Poor Maternal Effort
Prolonged Second Stage of Labor
Fetal Indications
Fetal Distress: During the second stage of labor
Cord Prolapse: During the second stage of labor
After-coming Head: In breech delivery
Post Maturity
Low Birth Weight
Contraindications
Absence of proper indication
Absence of full dilation of the cervix
Cephalo-pelvic disproportion
High station of fetal head
Uterine contraction ceases
Forceps Anatomy
Forceps vary in size and shape but consist of two crossing branches.
Each branch has four components:
Blade
Shank
Lock
Handle
Each blade has two curves:
Cephalic curve
Pelvic curve
Prerequisites for Forceps Delivery
Fetal head must be engaged, flexed, and preferably well-rotated.
No obvious cephalo-pelvic disproportion.
Cervix must be fully dilated and effaced.
Membranes must be absent.
Uterus must be contracting.
Bladder must be empty.
Rectum should preferably be empty.
Presentation and position must be suitable.
Baby should be living.
No undue obstruction.
Adequate analgesia (local anesthesia).
Equipment
Sterile delivery set
Episiotomy set
Forceps
Catheter
Emergency medicine
Resuscitation set
Suction
Oxygen
Preparation
Provide emotional support and encouragement.
Explain the purpose and procedure to the mother and obtain informed consent.
Prepare the sterile delivery set, episiotomy set, forceps, catheter, emergency medicine, resuscitation set, suction, oxygen, etc.
Inform pediatrician and prepare all necessary equipment and articles.
Wear sterile gloves, mask, and gown.
Wash vulva with antiseptic solution and place draping.
Pass a sterile catheter to remove urine.
Prepare according to normal delivery procedures.
Infiltrate the perineum and give episiotomy when indicated.
Procedure
The left blade is chosen first. Hold it vertically like a pen with the cephalic curve directed towards the vulva.
Introduce two fingers (middle and index) of the semi-supinated right hand into the posterio-lateral aspect of the vagina beside the head, keeping the thumb and other fingers outside.
Gently negotiate the left blade between the head and the internal fingers, using a gentle upward push of the thumb of the vaginal hand on the convex border of the fenestrated blade.
Lock the blades. If there is any difficulty in locking, depress the handles on the perineum. If there is further difficulty, withdraw the blades and perform a thorough vaginal examination to detect any malposition of the head.
Grip the handles of the forceps with the right hand and make traction during a uterine contraction. Perform a low forceps operation with a single continuous pull until the head is delivered. The direction of the traction is downward, forward, and finally upward.
Post-Delivery Management
If forceps delivery fails, perform a caesarean section.
Actively manage the third stage of labor following delivery of the head.
Resuscitate the newborn if needed and keep the newborn warm with skin-to-skin contact.
Important Notes
The head should descend with each pull.
Only 2 or 3 pulls should be necessary.
Complications
Maternal Complications
Immediate:
Soft tissue injuries to the cervix, vagina, perineum, and extension of episiotomy
Traumatic post-partum hemorrhage
Rupture of the uterus
Injury to bladder and rectum
Infection
Bladder atony
Fracture of the sacro-coccygeal joint
Fetal Complications
Asphyxia
Soft tissue injury to the face, bruising, and laceration