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Forceps Delivery Procedures

  • Author: Michael G Ross, MD, MPH; Chief Editor: Christine Isaacs, MD  more...
 
Updated: Mar 31, 2014
 

Background

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.

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Indications

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
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Contraindications

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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Contributor Information and Disclosures
Author

Michael G Ross, MD, MPH Professor of Obstetrics and Gynecology, University of California, Los Angeles, David Geffen School of Medicine; 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, Phi Beta Kappa, Society for Reproductive Investigation, Society for Maternal-Fetal Medicine, Society for Neuroscience, American Federation for Clinical Research, Perinatal Research Society, American Gynecological and Obstetrical Society, American Physiological Society, American Public Health Association, Association of Professors of Gynecology and Obstetrics

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Lumara Health; Cervilenz Inc<br/>Received income in an amount equal to or greater than $250 from: Lumara Health; Cervilenz Inc.

Coauthor(s)

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.

Specialty Editor Board

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.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

References
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Simpson forceps, labeled to show parts of the instrument. This version has a fenestrated blade.
Luikart modification of the Simpson forceps. Note the semi-fenestrated blade.
Kjelland forceps. These are used for rotation of the fetal head and have no pelvic curve. The shanks overlap, causing less distention of the maternal perineum.
An illustration of a forceps delivery technique.
The left handle is held in the left hand (Simpson forceps).
The left blade is introduced into the left side of the pelvis.
The left blade is in place and the right blade is introduced by the right hand.
A median or mediolateral episiotomy may be performed at this point. A left mediolateral episiotomy is shown here.
The forceps have been locked. The inset shows a left occipitoanterior fetal position.
An illustration of horizontal traction with the operator seated.
An illustration of upward traction.
An illustration of disarticulation of the branches of the forceps; beginning modified Ritgen maneuver.
 
 
 
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