Characteristics of the obstetric forceps Birth by forceps Characteristics of the obstetric forceps

l obstetric forceps are composed of two separate blades right and left insertion around the fetal head within the maternal vagina two shanks (shahs) of varying length and two handles. Forceps are two type *non- rotational * rotational.

The blades have a cephalic curve to accommodate the form of the baby's head and are fenestrated (and not solid) to minimize the trauma to the baby's head during both placement and birth. They also have a pelvic curve to reduce the risks of trauma to the maternal tissues during the birth process. the blades are correctly positioned around the fetal skull Will be noted to ‘lock with ease’. Forceps that do not lock are most commonly incorrectly placed.

Classification of obstetric forceps -Forceps into two categories: * mid-cavity *and low-cavity. Mid-cavity forceps are used when the leading part of the fetal head has reached below the level of the Ischial spines; low-cavity forceps are used when the head has descended to the level of the pelvic floor. High-cavity forceps (with the leading part of the fetal head above the level of the ischial spines) are now considered unsafe and a CS will be the preferred method of birth in nearly all cases.

Types of obstetric forceps Wrigley's forceps -used when the head is on the perineum or to assist the birth of the fetal head at caesarean section. They have a short shank, fenestrated blades with both pelvic and cephalic curves, and an English lock

Neville–Barnes or Simpson's forceps used for a low- or mid-cavity forceps birth when the sagifal suture is in the anteroposterior diameter of the cavity of the pelvis. they have cephalic and pelvic curves to the fenestrated blades the handles are longer and heavier than those of the Wrigley's.

Kielland's forceps designed to deliver the fetal head at a station at, or above, the pelvic brim. They are now more commonly used for the rotation and extraction of a baby whose head is in the deep transverse or occipitoposterior Malposition. It allow for the safe rotation of the fetus),

Procedure explain & Rationale consent urinary bladder catheterization, FHR monitoring position of the woman's legs Consideration to the location of the birth( labor room ,or theater ) inhalational analgesia or a pudendal nerve block with perineal infiltration is unlikely to be sufficient for a forceps birth. an epidural, if already in situ, may be topped up, or a spinal anaesthetic should be administered,is given to using Kielland's forceps.

will be inserted per vagina) and placed around the fetal head. The left blade is inserted before the right blade, with the other hand protecting the vaginal wall from direct trauma. The forceps blades come to lie parallel to the axis of the fetal head, and between the fetal head and the pelvic wall. then articulates and locks the blades, checking their application before applying traction. Traction should be applied in concert with uterine contractions and maternal expulsive efforts.

Complications of instrumental vaginal birth forceps are less likely than the ventouse to fail to achieve a vaginal birth,likely to be associated with third- or fourth-degree tears (with or without the concurrent use of an episiotomy) vaginal trauma use of general anesthesia flatal, faecal and urinary continence

Maternal complications Trauma or soft tissue damage – occurring to the cervix, vagina or perineum. Dysuria or urinary retention, which may result from bruising or edema to the tissues around the urethra. Perineal discomfort. Hemorrhage (both from tissue trauma and also uterine atony – the risk of which is always increased following an assisted vaginal birth).

Neonatal complications Marks on the baby's face and bruising (commonly caused by the pressure from the forceps blades and around the caput succedaneum/chignon from the ventouse , all of which resolve within 48–72 hours after birth Facial palsy, which may result from pressure from a blade compressing a facial nerve (a transient problem in most instances). Prolonged traction during a birth with a ventouse will increase the likelihood of scalp abrasions, cephalohaematoma or sub-aponeurotic bleeding

Failure With the ventouse Failure to select the correct cup type inappropriate use of the silastic cup ,especially in the presence of: @ deflexion of the fetal head @ excess caput @‘dense’ epidural block @ fetal macrosomia (true CPD). @Failure of the equipment to provide adequate traction @Incorrect cup placement – too anterior or lateral,

Failure With any instrument Inadequate case assessment high head misdiagnosis of the position and attitude of the head. along Traction Poor maternal effort with inadequate use of syntocinon

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