Forceps

Principle

The forceps are instruments of Extraction of the fetus out of the genital ways at the time of a Accouchement. Contrary to the Vacuum extractor which is satisfied to bend the head of the child, the forceps is a real instrument of traction which makes it possible to mitigate an insufficiency of the uterine contractions or efforts maternal.

It consists of two metal “spoons” that the operator slips one after the other, inside the Vagin initially, then along fetal cranium, according to a quite precise provision which avoids the lesions of the head and the face of the child. These spoons are then solidarized one with the other is by crossing by forming a grip then (forceps with cross branches of Pajot, Tarnier, Simpson…), that is to say via a transverse branch (forceps with parallel branches of Demelin, of Suzor…).

One carries out then tractions regular and moderate on the instrument, so as to help the child in his descent and his expulsion of the genital ways.

The forceps also have, in certain cases, summer used for a Embryotomie.

History and evolution

Place des forceps in the history of obstetrics

Which proportion of the childbirth with forceps, today

Indications of the forceps

The forceps are indicated in the event of need for carrying out a fetal extraction in urgency, whenever the maternal action is insufficient in term of time or impossible. They are applicable only on the cephalic part of the fetal mobile. In all the situations, the fetal head will have to thus be sleep and already committed in the basin (crossing of the higher strait). The various indications are:

  1. acute fetal Suffering: anomaly of the fetal cardiac rhythm recorded by cardiotocography testifying to a fetal suffering or signals electrocardiographic testifying to an acidosis (monitoring by STAN)

  2. Not progression of the presentation after 30 minutes of regular efforts expulsifs led well
  3. intense maternal Tiredness with insufficient efforts expulsifs
  4. Counter-indication to the maternal efforts expulsifs
  5. Retention of last head during the childbirth of the seat
  6. Difficulties of fetal extraction at the time of a Cesarean generally on uterine hypertonicity, either in cephalic presentation, or within the framework of a retention last head on the level of the hysterotomy
  7. Procidence of the cord committed head and " pretense; easily accessible" with the instrumental extraction

Risk factors leading to the use of the instrumental extractions

Risks related to the use of the forceps

Maternal risks

The maternal risks are those of the fast childbirth plus those related to the lesions being able to be produced by the installation of the spoons.

  1. vaginal Wounds, side vaginal désinsertion or of the recto-vaginal partition, important risk factor of the formation of a thrombus

  2. Tear périnéale of degree I (simple); II (périné complete noncomplicated) or III (périné complete complicated) followed sometimes dents obstétricales
  3. cervical Wounds: tear of the collar
  4. massive Hemorrhage related to these various lesions
  5. nervous Lesions (ashamed nerves)
  6. vesical, urethral Lesions exceptional in the event of massive dilapidation of the former wall of the vagina
  7. osseous Lesions: fracture coccygienne
  8. urinary and/or anal functional Incontinence (with gases or fecal)
  9. dependant Complications the episiotomy (disunion, infection…)
  10. psychological Dyspareunies
  11. Traumatism, factor of anxiety for a possible later pregnancy

Fetal risks

Comparison between the forceps and other methods

Forceps or suction cup

Forceps or Cesarean

Medico-legal risks related to the choice of the forceps

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