FORCEPS

DEFINITION Obstetrics forceps is a pair of instruments specially designed to assist extraction of the fetal head and thereby accomplishing delivery of the fetus.

DESIGN OF FORCEPS Blades Shank Lock handle Axis traction device

TYPES HIGH FORCEPS OPERATION BP diameter has not yet passed the plane of pelvic inlet MID FORCEPS OPERATION BP diameter has passed the plane of inlet but has not passed the level of ischial spine High mid BP diameter above the level of ischial spine Low mid BP diameter at the level of ischial spine LOW FORCEPS OPERATION BP diameter has passed the level of ischial spine OUTLET FORCEPS Head lying on the perineum and visible at the introitus in between contraction

FUNCTION Traction: - Pull required in a primigravida is 18 kgs & in a multipara it is 13 kgs. Compression effect: -However it has some pressure effect on the well-ossified base of the skull. Rotation of head Protective cage As a vectis: - By applying one blade to deliver the head in caesarean section.

INDICATIONS DELAY IN THE SECOND STAGE FETAL INDICATION Fetal distress Cord prolapse After coming head of breech Low birth weight baby Postmaturity

Contd…. MATERNAL INDICATION Maternal distress Pre – eclampsia Post cesarean pregnancy Heart disease

Conditions to be fulfilled The head must be engaged The fetus must present as a vertex or by the face with the chin anterior. The cervix must be completely dilated and effaced Membrane must be rupture There should not be undue obstruction Baby should be living Uterus should be preferably contracting and relaxing The bladder must be emptied

TECHNIQUES: 1.ANESTHESIA – 1% LIGNOCAINE HYDROCHLORIDE

Contd… STEPS Identification of the blades and their application 2. CATHETERISATION 3. EPISIOTOMY STEPS Identification of the blades and their application Locking of the blades Traction Removal of the blades

MATERNAL COMPLICATIONS IMMEDIATE Injury PPH Shock Sepsis Anaesthetic hazards REMOTE Chronic low backache Genital prolapse Stress incontinence

FETAL COMPLICATIONS IMMEDIATE Asphyxia Intracranial haemorrhage Cephalhaematoma Facial palsy Abrasions on the soft tissues of the face REMOTE Cerebral and spastic palsy due to residual cerebral injury

FETAL COMPLICATIONS