Forceps are metal instruments used in an operative vaginal delivery by applying traction to the fetal head. Over the last few decades, the long term safety to the fetus of forceps operative vaginal deliveries has come into question and the use of forceps to accomplish a vaginal delivery has become much less common than before the 1970's. Information supporting a higher incidence of long-term adverse consequences to the newborn further contributed to the decrease in forceps use.
At present, forceps assisted operative vaginal deliveries account for less than 5% of vaginal deliveries. A variety of forceps instruments have particular designs for a particular purpose. Most widely used are the Simpson, Tucker, DeLee and Piper for the aftercoming head in a breech delivery. Forceps deliveries are classified in accordance with the level of descent of the leading bony point of the fetal head in the mother's pelvis. Types of forceps deliveries include:
Indications for operative vaginal delivery are similar for forceps and vacuum extractors. Taking into account that no indication is an absolute, they include:
Prolonged second stage without cephalopelvic disproportion
Immediate or potential fetal compromise during the second stage of labor
Interruption of second stage of labor because of acute bleeding, cardiac disease, pulmonary disease or maternal exhaustion (see below)
Operative vaginal delivery with forceps should not be undertaken without a valid indication. Attempts to shorten labor for maternal and/or physician's convenience does not support the use of forceps at any time. Maternal exhaustion, although a valid indication at times, requires the medical provider to assess the underlying reason for the maternal exhaustion. Prolonged labors are quite often an indication of the presence of cephalopelvic disproportion or fetal malposition. Cephalopelvic disproportion exists when the the dimensions of the fetal head are larger than the dimensions of the maternal pelvis. Delivery of such an infant can only be accomplished at the expense of a contraindicated compression of the fetal head. Before forceps can be used, some prerequisites must be fulfilled. They include:
Amniotic membranes must be ruptured
Type of pelvis must be known
Cervix must be fully dilated
Position of the fetal head must be known
Fetal head must be engaged in the pelvis
No cephalopelvic disproportion is present
Adequate anesthesia given
Physician must be fully trained in the use of forceps
Operative vaginal delivery increases the risk of neonatal intracranial bleeds when compared with normal spontaneous vaginal delivery or cesarean section. Complications associated with forceps operative vaginal deliveries can be divided into maternal complications and fetal complications. Maternal complications include:
Lacerations of the vagina
Lacerations of the cervix
increase in blood loss
Injury to the urinary bladder
Anal sphincter injuries
Fetal complications associated with the use of forceps for an operative vaginal delivery include:
Transient facial bruising or lacerations
The combined use of operative vaginal delivery instruments such as vacuum extractor followed by forceps delivery (or viceversa) or the multiple attempts such as more than 3 traction episodes to accomplish delivery is clearly contraindicated. Regardless of the ultimate success in accomplishing a vaginal delivery under these circumstances, the risk of neonatal intracranial hemorrhage is markedly increased.
If your child was delivered by forceps and is now suffering from a birth related injury, or you are suffering from a maternal complication, Dr. Borten and the Boston area medical malpractice attorneys at Gorovitz & Borten can help you assert your rights and get the compensation you deserve.
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