Chapter 244 Forceps-Aided Delivery
DESCRIPTION
Forceps-aided delivery is a method of assisting or expediting vaginal vertex delivery through the application of obstetric forceps. (Discussion here is limited to low or outlet forceps with the fetus presenting within 45 degrees of directly occiput anterior.)
INDICATIONS
Fetal: nonreassuring fetal status, acute fetal distress. Maternal: fatigue, prolonged second stage of labor (nulliparous women: lack of continuing progress for 3 hours with regional anesthesia or 2 hours without regional anesthesia; multiparous women: lack of continuing progress for 2 hours with regional anesthesia or 1 hour without regional anesthesia), certain types of pulmonary, cardiac, or neurologic disease.
CONTRAINDICATIONS
Incompletely dilated cervix, significant fetal malpresentation, unengaged fetal head, intact fetal membranes, inability to assess fetal position or obtain maternal cooperation, distorted or contracted maternal pelvic anatomy, gestational age less than 34 weeks, fetal demineralization or clotting disorder.
TECHNIQUE
Adequate maternal anesthesia or analgesia should be ensured in all but the most extreme circumstances. Whenever possible, the maternal bladder should be emptied (by catheter). The exact position of the fetal head must be ascertained by palpation of the sagittal suture and fontanels. All other preparations for vaginal delivery should be in place before forceps are applied.
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