Forceps Delivery Procedures
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A forceps is an instrument designed to aid in the delivery of the fetus by applying traction to the fetal head. Many different types of forceps have been described and developed. Generally, a forceps consists of 2 mirror-image metal instruments that are articulated. The blades of the forceps are maneuvered to cradle the fetal head, after which traction is applied to effect delivery.
It is important to emphasize that forceps delivery is skill-dependent and training-dependent. The operator must have a clear understanding of his or her own capabilities, as well as the safe limits of the procedure, and must not exceed either of these.
The following indications for forceps-assisted delivery apply when no contraindications exist [1, 2] :
Prolonged second stage of labor – This includes nulliparous women with failure to deliver after 2 hours without and 3 hours with conduction anesthesia; it also includes multiparous women with failure to deliver after 1 hour without and 2 hours with conduction anesthesia
Suspicion of immediate or potential fetal compromise in the second stage of labor
Shortening of the second stage of labor to benefit the mother – Maternal indications include, but are not limited to, exhaustion, bleeding, cardiac or pulmonary disease, and a history of spontaneous pneumothorax
In skilled hands, fetal malposition, including the after-coming head in breech vaginal delivery, can be indications for forceps delivery.
Prerequisites for forceps delivery include the following [2] :
The head must be engaged
The cervix must be fully dilated and retracted
The position of the head must be known
Clinical assessment of pelvic capacity should be performed; no disproportion should be suspected between the size of the head and the size of the pelvic inlet and midpelvis
The membranes must be ruptured
The patient must have adequate analgesia
Adequate facilities and supportive elements should be available
The operator should be competent in the use of the instruments and the recognition and management of potential complications; he or she should also know when to abort a procedure that is not proceeding appropriately
The following are contraindications to forceps-assisted vaginal deliveries:
Any contraindication to vaginal delivery (see Normal Labor and Delivery)
Inability to obtain adequate verbal consent
A cervix that is not fully dilated or retracted
Inability to determine the presentation and fetal head position
Inadequate pelvic size
Confirmed cephalopelvic disproportion
Unsuccessful trial of vacuum extraction (relative contraindication)
Absence of adequate anesthesia or analgesia (relative contraindication)
Inadequate facilities and support staff
An insufficiently experienced operator
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Michael G Ross, MD, MPH Distinguished Professor of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine; Distinguished Professor, Department of Community Health Sciences, Fielding School of Public Health at University of California at Los Angeles
Michael G Ross, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American College of Obstetricians and Gynecologists, American Federation for Clinical Research, American Gynecological and Obstetrical Society, American Physiological Society, American Public Health Association, Association of Professors of Gynecology and Obstetrics, Perinatal Research Society, Phi Beta Kappa, Society for Maternal-Fetal Medicine, Society for Neuroscience, Society for Reproductive Investigation
Disclosure: Nothing to disclose.
Marie Helen Beall, MD Clinical Professor of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine
Marie Helen Beall, MD is a member of the following medical societies: American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, American Society of Human Genetics
Disclosure: Nothing to disclose.
Jori S Carter, MD, MS Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine
Jori S Carter, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, Society of Gynecologic Oncology, Association of Women Surgeons, International Society for Magnetic Resonance in Medicine, American Society of Clinical Oncology
Disclosure: Nothing to disclose.
Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center
Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology
Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.
Forceps Delivery Procedures
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