The main differences between the two are that the Simpson forceps have shanks that are separated (remember “Simpson shanks separated”) whereas those of the Elliot/Tucker-McLane type are overlapping (remember “Tucker tucked in”). Types of forceps The two most commonly used types of forceps for the cephalic presenting fetus are Simpson type and Elliot or Tucker-McLane forceps. 8Īnatomy of the forceps The basic anatomy of the forceps is described in the video, “ Anatomy of the forceps” 7 Given the importance of correct determination of fetal position, it is reasonable to consider a bedside ultrasound in patients for whom a forceps delivery is being considered an excellent expert review was published on the topic by Bellussi, et al and includes an accompanying video demonstrating the technique. 5-7 Ultrasound assessment, on the other hand, has consistently proven more accurate than digital palpation, including in a large, multicenter randomized trial where the accuracy of ultrasound assessment was found to be 98.4%. Provider determination of fetal head position is fraught with error with studies showing accuracy ranging from 27% to 80% by digital palpation even by experienced providers. 4Īssessment of fetal position Knowledge of the fetal head position is particularly critical for forceps deliveries, since it determines the type of forceps delivery being performed (Table 2) and incorrect assessment of position can make forceps placement both less effective and more prone to cause fetal injury. But while vacuum delivery has been discouraged for the fetus less than 34 weeks, there is no lower limit for gestational age for forceps delivery. A helpful mnemonic for recalling these may be to remember A-B-Cs and is described in Table 1.Ĭontraindications for both forceps and vacuum include a strong suspicion for a fetal bone demineralizing or bleeding disorder. At a system level, there should be a willingness and ability to have a back-up plan in place in case of failure to deliver. Regarding the patient, adequate anesthesia should be in place, the bladder empty, and consent obtained. An estimation of fetal weight, fetal position, and pelvic adequacy should also have been previously performed. Prerequisites include the cervix being fully dilated, membranes ruptured, and the head being fully engaged. Indications and contraindications for forceps deliveries Indications and prerequisites for proceeding with a forceps delivery mirror those for a vacuum delivery and include prolonged second stage of labor, suspicion of fetal compromise, and shortening of the second stage for maternal benefit. And though some modifications were made in the following years, the two most commonly used forceps designs of today – Simpson and Elliot-type forceps – were each invented about a century and a half ago. The secret method ultimately remained with the family for another century and the instruments unseen until their discovery under the floorboards of Peter’s son’s house in 1813. The two male midwives were so maligned, however, and so obsessed with the secrecy of their invention that before employing the forceps they would make all attendees leave the room and blindfold the laboring woman before applying them. Invented by the two Chamberlen brothers (Peter the Elder and Peter the Younger) in the 1600s, the timing was particularly fortuitous because malnourishment, rickets and thus pelvic dystocia were on the rise. History The history of the obstetric forceps is one of the more theatrical tales in medical literature. ![]() It is these latter deliveries – forceps-assisted vaginal deliveries – which will be the focus of this article. ![]() While approximately 10% of deliveries were performed via operative delivery in the 1990s, the most recent National Vital Statistics Survey shows a 2.58% rate for vacuum deliveries and 0.56% for forceps deliveries. 2 Despite this, the overall trend for operative deliveries has shown a dramatic decline. ![]() 1 The top two reasons for cesarean delivery – labor dystocia and abnormal or indeterminate fetal heart rate tracings – can both potentially be resolved by operative vaginal delivery. Notably, 2017 was the first year the cesarean delivery rate increased since 2009, suggesting an even greater urgency in focusing on tools to reduce it. It can reduce the need for cesarean deliveries, an important goal of both our specialty nationwide and of individual providers and patients. Operative vaginal delivery remains an important skill for obstetricians to provide the full spectrum of care for pregnant patients.
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