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Forceps Delivery

Over the last two decades, the frequency of forceps delivery has declined significantly as the cesarean delivery rate escalated. Fear of fetal injury and subsequent litigation have been at least partially responsible for this trend forceps delivery, forcep.

Also responsible were inadequate definitions that grouped relatively easy deliveries, with the fetal head at or near the pelvic floor, with higher, more difficult deliveries that included rotation of more than 90 degrees. The ACOG classification categorized forceps deliveries according to station of the fetal head and degree of rotation required. The pelvis is subdivided by using centimeters from the ischial spines to the introitus (0 to +5) rather than the

Forceps can be used to benefit the mother, fetus, or both. Maternal cardiac or neurologic conditions may prevent or contraindicate pushing; more often, maternal fatigue or an improperly dosed epidural may impede expulsive efforts. Nonreassuring FHR patterns may mandate delivery.

Forceps delivery is indicated when a nulliparous woman has experienced arrested descent for 2 hours (3 hours with epidural anesthesia) and when a multiparous woman has had arrested descent for 1 hour (2 hours with an epidural anesthesia). Such decisions are individualized based on

When a forceps delivery is contemplated, a number of prerequisites should be met:

• Assessment of maternal pelvis-fetal size

• Adequate anesthesia

• Willingness to abandon attempted operative vaginal delivery

• Ability to

All attempts should be viewed as a trial with a willingness to desist when difficulty is encountered either with application or with traction. Except for emergent deliveries, the patient should be thoroughly counseled regarding the

The patient should be comfortably positioned in the dorsal lithotomy position with an empty bladder. Pudendal anesthesia is adequate for outlet procedures, whereas higher forceps require regional or general anesthesia. Before application, the operator confirms full dilatation and rupture of membranes. Clinical pelvimetry should rule out obvious cephalopelvic disproportion. Accurate assessment of fetal head position ensures proper symmetrical, bimalar, and

Cesarean Birth

Advances in anesthetic technique, blood transfusion, and antibiotics have made cesarean delivery safer, with a maternal mortality of 5-14 in 100,000 live births after adjusting for coexisting complications. Nonetheless, abdominal delivery results in a 1.5- to 7-fold increase in maternal mortality and a significant increase in morbidity, including

The four most common indications for cesarean delivery in the United States are prior cesarean delivery, dystocia, fetal distress, and breech presentation. Considerable attention to reducing the present cesarean delivery rate has been focused on deliveries performed for prior cesarean delivery and dystocia, which together account for two thirds of all abdominal deliveries. Interventions to lower the cesarean delivery rate should include encouragement for women to

Classification of Forceps Deliveries According to Station and Rotation

Type of Procedure	Classification

Outlet forceps	1) Scalp visible at introitus without labial separation 2) Fetal skull has reached the pelvic floor 3) Sagittal suture is in anteroposterior diameter or right or left occiput anterior or posterior position 4) Fetal head is at or on perineum 5) Rotation does not exceed 45 degrees
Low forceps	Leading point of fetal skull is at station $+2 cm and not on the pelvic floor a. Rotation #45 degrees (left or right occiput anterior to occiput anterior or left or right occiput posterior to occiput posterior b. Rotation >45 degrees
Mid forceps	Station above +2 cm but head engaged
High forceps	Not included in classification