Forceps Delivery Procedures Periprocedural Care

Updated: Apr 11, 2017
  • Author: Michael G Ross, MD, MPH; Chief Editor: Nicole W Karjane, MD  more...
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Periprocedural Care

Equipment

A forceps has 4 major components, as follows (see the images below) [3] :

  • Blades - The blades grasp the fetal head, and each one is curved to fit around the head; they can be oval or elliptical and can be fenestrated (with a hole in the middle) or solid; many blades are also curved in a plane 90° from the cephalic curve to fit the maternal pelvis (pelvic curve)
  • Shanks - The shanks connect the blades to the handles and provide the length of the device; they are either parallel or crossing.
  • Lock - The lock is the articulation between the shanks; many different types have been designed
  • Handles - The handles allow the operator to hold the device and to apply traction to the fetal head
    Simpson forceps, labeled to show parts of the inst Simpson forceps, labeled to show parts of the instrument. This version has a fenestrated blade.
    Luikart modification of the Simpson forceps. Note Luikart modification of the Simpson forceps. Note the semi-fenestrated blade.
    Kjelland forceps. These are used for rotation of t 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.
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Patient Preparation

Anesthesia

An adequate level of anesthesia should be in effect before application of the forceps. Although a meta-analysis by Nikpoor and Bain found no objective evidence to support the use of one method of analgesic over another, [4] the available evidence is scanty.

Although published reports suggest that local infiltration of anesthetic into the perineal body may be sufficient by itself, the authors believe that this type of anesthesia is often less than adequate. Very few women can tolerate forceps application without, at a minimum, pudendal block anesthesia. Attempts to initiate delivery with inadequate anesthesia may prove intolerable to the mother. Pudendal block anesthesia may be augmented with intravenous (IV) sedation.

Adequate anesthesia is also achievable with regional or general techniques. Regional anesthesia is most frequently used; general anesthesia is usually reserved for very unusual emergency situations. With the former, the patient should be prepared and draped after the anesthetic has been delivered via epidural or spinal injection. With the latter, the surgeon should be ready and the patient properly draped before the general anesthetic is administered.

Positioning

Forceps deliveries are most often performed with the parturient in the lithotomy position.

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