CASE DESCRIPTION
  • Forceps are an instrument commonly used in obstetrics to facilitate safe assisted vaginal birth.
  • Forceps offer a safe method of vaginal birth when performed by a skilled operator, under appropriate indications, with unique benefits compared to vacuum birth or cesarean delivery at full dilatation.
  • Simpsons, Neville-Barnes, and Tucker-McLean forceps are the most commonly used types. They are recommended when the fetus is in an occiput anterior position. This video will focus on the use of Simpsons forceps.
  • Comprehensive abdominal and vaginal examinations must be performed to confirm that the patient meets all criteria to proceed safely.
  • If there is concern about fetal status or failure, the delivery should be performed in the operating room where a quick conversion to cesarean section is possible.
  • Maternal risks for routine forceps delivery include:
    • Episiotomy
    • Obstetrical anal sphincter injuries (third or fourth degree tears)
    • Vaginal tears or hematoma
    • Postpartum hemorrhage
    • Urinary tract damage
    • Long term-sequelae including pelvic floor dysfunction
  • Fetal risks include:
    • Facial marks, bruising and or lacerations
    • Shoulder dystocia
    • Facial nerve palsies (extremely rare)
    • Ocular trauma (extremely rare)
    • Skull fractures (extremely rare)
    • Intracranial hemorrhage (extremely rare)
  • In addition to the primary care provider, the following personnel should also be present during routine forceps delivery:
    • Nursing or Midwifery
    • Anesthesia
    • Expert in neonatal resuscitation
    • Patient supports
  • The procedures should be documented thoroughly, including examination of the newborn, maternal lacerations and estimated blood loss.
  • The procedure is completed by debriefing with the patient, support persons and the clinical team, including arranging appropriate follow up as required.

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