Forceps Delivery

Chapter 17 Forceps Delivery



Common indications


A forceps delivery is commonly indicated to assist in the completion of the second stage of labor for patients with inadequate propulsive force to deliver their infants. The physician should clearly identify the indication for the procedure, which most often includes maternal exhaustion, fetal distress, or soft-tissue dystocia that impairs the descent of the infant. The risks of the procedure—facial trauma for the infant, maternal lacerations, pelvic floor trauma, fetal intracerebral injury, and the failed attempt at instrumented delivery with the requirement of a cesarean delivery—should all be discussed with the mother as part of the consent for the procedure (Figure 17-1).


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FIGURE 17-1 Forceps delivery.



Equipment


Simpson’s forceps are the most widely accepted outlet forceps in use. There are three parts to the forceps: handle, shanks, and blades. The two blades articulate just above the handles. Unpack the two blades from the sterile pack, and reconnect them to ensure that you have a complete set of forceps before proceeding (Figure 17-2).


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FIGURE 17-2 Simpson’s forceps (fenestrated).



Key steps



1. Preparation: Determine the fetal head position, station, and rotation, if present. Consider the use of a pudendal block for anesthesia, if no other block is present. Ensure that the cervix is fully dilated and that the bladder is empty. Anticipate that a shoulder dystocia could occur with any assisted delivery. Consider whether an episiotomy is indicated or whether it is likely needed to expedite the delivery. It is optimal to cut a mediolateral episiotomy to reduce the risk of rectal sphincter injury.

2. Insertion of the left blade: The left blade is first inserted, using the left hand to grasp the left blade handle, and the right hand is inserted into the vagina to protect the left mate-rnal sidewall during insertion. Insert the blade flat on the posterior aspect of the vagina, and use the internal hand to guide the blade laterally and deep around the fetal head (Figure 17-3, A, B).

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Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Forceps Delivery

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