INDICATIONS MATERNAL Exhaustion Prolonged second stage Cardiac
/ pulmonary disease FETAL Failure of the fetal head to rotate Fetal
distress Should not be used for preterm, face presentation or
breech
Slide 7
MNEMONIC A Anesthesia adequate appropriate positioning &
access B Bladder catheterization C Cervix fully dilated / membranes
ruptured D Determine position, station, pelvic adequacy E Equipment
inspect vacuum cup, pump, tubing, check pressure
Slide 8
MNEMONIC F Fontanelle position the cup over the scalp, avoid
fontanelle -ve pressure 10 cm H2O initially & between cont
sweep finger around cup to clear maternal tissue pressure to 60 cm
H2O with the next contraction G Gentle traction pull with
contractions only traction in the axis of the birth canal ask the
mother to push during cont
Slide 9
MNEMONIC H Halt halt traction if no progress with three
traction aided contractions vacuum pops off three times pulling for
30 min without significant progress I Incision consider episiotomy
if laceration imminent J Jaw remove vacuum when jaw is reachable or
delivery assured
Slide 10
COMPLICATIONS Vacuum assisted delivery is less traumatic to the
mother & fetus than forceps Ventouse should be the instrument
of choice Maternal Vaginal laceration due to entrapment of vaginal
mucosa between suction cup & fetal head
Slide 11
Comparative Advantages of Vacuum Extractors and Forceps Vacuum
extractors Easier to learn Quicker delivery Less maternal genital
trauma Less maternal discomfort Fewer neonatal craniofacial
injuries Less anesthesia required Forceps Fewer neonatal injuries,
including cephalohematoma, retinal hemorrhage Higher rate of
successful vaginal delivery
FETAL COMPLICATIONS Birth asphyxia 2.6-12% related to
extraction force & time Some studies showed decrease birth
asphyxia Retinal hemorrhage 50% Forceps 31% SVD 19% Neonatal
jaundice
Slide 14
Slide 15
FORCEPS HISTORY WILLIAM CHAMBERLAIN Fled from France in 1569
& practiced forceps delivery as a family secret in Southampton.
This was kept as a family secret for over 100yrs and four
generations. He had two sons. Peter I - had greater distinction
& attended notable women in society. Peter II - who had several
sons, died in 1626.
Slide 16
HYSTORY Levret (1747)-introduced the pelvic curve Smellie
(1751)- reinforced pelvic curve & introduced English lock and
used in aftercoming head. Tarnier (1877)-introduced axis traction.
Barton and Kjielland - introduced the two specialized forceps.
Slide 17
Functions Traction: -This is the most important function. Pull
required in a primigravida is 18 kgs & in a multipara it is 13
kgs. Compression effect: -This is minimal when properly applied
& should not be more than necessary to grasp the head. However
it has some pressure effect on the well- ossified base of the
skull.
Slide 18
Functions Rotation of head: -This occurs with the use of
Kejilland's forceps and also in low forceps cephalic application
with the occiput in the 2 or 10 'o' clock position. Protective
cage: - When applied on a premature baby it protects from the
pressure of the birth canal. When applied on the aftercoming head
it lessens the sudden decompression effect.
Slide 19
19 Indications for forceps delivery Delay in second stage: -.
Due to uterine inertia. Failure of progress of labour- if no
progress occurs for more than 20 to 30 minutes, with the head on
the perineum. Definition of prolonged second stage of labour
redefined by A.C.O.G.(1988/1991): - Nullipara-