Obstetric forceps. The operation of applying obstetric forceps Consequences of applying obstetric forceps

Obstetric forceps are one of the oldest instruments for obstetrics, designed for extracting a live, full-term fetus by the head.

Obstetric forceps were invented in Scotland at the end of the 16th century, and began to be used in Russia starting in 1765.

The design of obstetric forceps has not changed since their invention; they consist of two metal spoon-shaped branches connected into a lock in a special way.

Forceps are used during weak labor, when the woman in labor is unable to push out the fetus on her own, and the condition of the child or mother requires completion as quickly as possible. Also, with the help of obstetric forceps, the obstetrician can turn the fetus, which is located in the gluteal region, head down to facilitate the birth process.

The benefits and dangers of forceps

There are a number of indications for the use of forceps when the fetus or mother is in serious danger, so most often the use of forceps outweighs the risk of possible complications.

However, applying forceps can be accompanied by serious complications. For the mother, they consist of damage to the birth canal: ruptures of the vagina and perineum. In severe cases, these may be ruptures of the cervix and lower segment of the uterus, damage to the bladder and rectum.

There may also be a number of complications for the fetus, primarily swelling and cyanosis in the soft tissues of the head, hematomas due to strong compression of the forceps, and paresis of the facial nerve. The most severe complications are damage to the bones of the child’s skull.

The use of obstetric forceps is not the only possible cause of complications, but it significantly increases their risk.

Correct and timely application of forceps usually does not lead to serious complications. They are used when the cervix is ​​fully dilated and the widest part of the baby's head is under the pubic bone in the woman's pelvis. In addition, when using them, pain relief is necessary, most often this is short-term intravenous anesthesia, which also facilitates the course of labor.

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Output tongs

1. Preparation:

• placing the woman in labor on a “transverse” bed;
• treatment of the hands of the operator and assistant (the method is the fastest possible under these conditions);
• treatment of the surgical field (external genitalia, inner thighs, perineum) with an antiseptic solution;
• bladder catheterization;
• anesthesia (preferably general anesthesia, pudendal anesthesia - with exit forceps);
• collecting the tongs and laying the branches on the work table (Figure 1);
• internal examination with a “half-hand” or two fingers to clarify the condition of the birth canal, presentation, type, position, position, sagittal suture and determine the level of the head.

Rice. 1. Collecting the tongs and laying the branches on the work table

2. Operation technique:

• insertion and placement of forceps spoons. Four fingers of the right hand are inserted into the left half of the pelvis in the direction of the sacroiliac joint (Fig. 2). With the left hand, the left spoon of the forceps is grasped by the handle in the form of a bow or with three fingers, its top is placed in the groove between the index and middle fingers, and the handle is deflected towards the opposite groin. Under the control of the hand inserted into the vagina, the thumb moves along the lower branch, without violence the spoon itself is placed on the head along its greatest curvature, and the parietal tubercle is grabbed. The handle of the left spoon is easily lowered. The spoon is passed to the assistant, who holds it in the given position. The right spoon is also inserted under the control of the left hand (Fig. 3).

Rice. 2. Placement of the left spoon of forceps

Rice. 3. Insertion of the right spoon with forceps

• closing the forceps: the right spoon, when correctly applied to the head, easily fits into the lock of the left one: Bush hooks are at the same level for shock absorption, a diaper is placed between the jaws (Fig. 4),

Rice. 4. Closing the forceps

• control of the correct application of the forceps: with two fingers of the right hand, check whether the cervix is ​​captured between the jaws of the forceps and the head. The left hand supports the pliers by the handles,
• test traction (Fig. 5). We place the right hand on top of the handle of the forceps - the left one overlaps the right one, the middle finger touches the head. Light traction is applied. If this does not increase the distance between the head and the finger - therefore the forceps do not slip - they are applied correctly. If the distance increases, the forceps are applied incorrectly; they must be removed by removing the spoons in the reverse order, first the right one, tilting the handle of the forceps to the left groin of the woman in labor, and then the left one;

Rice. 5. Test traction

• traction itself. Hand position: 1) classic - the right hand grabs the handles in such a way that the index and middle fingers rest on the hooks (Fig. 6). The left hand repeats the position of the right, or also grabs the handles of the tongs from below. 2) according to Tsovyanov - after inserting the spoons and closing the forceps, the second and third fingers of both hands, bent with a hook, grasp the outer and upper surfaces of the instrument at the level of the Bush hooks. The main phalanges of the index fingers are located on the outer surface of the handles, with the Bush hooks passing between the main phalanges of the index and middle fingers. The fourth and fifth fingers grasp parallel forceps. The thumbs are under the handles of the tongs.

Rice. 6. Traction itself

Tractions are performed along the axis of the birth canal, taking into account the biomechanism of labor and the nature of the operation (abdominal or exit). Tractions are performed in a horizontal direction and upward (in 2 positions). The amount of traction depends on the position of the head in the cavity or at the pelvic outlet.

Removing the head before the parietal tubercles erupt, the spoons of the forceps are removed using the method described above in the reverse order (Figure 7 a, b).

Obstetric forceps are used for surgical delivery. Often, mothers in labor have many questions about their use during childbirth. We will try to answer the most popular of them.

Are obstetric forceps applied only to the head or also to the buttocks of the fetus?

Yes, forceps can also be applied to the child’s buttocks, but only if they (the buttocks) fit tightly into the entrance of the small pelvis, and it is impossible to place a finger behind the groin fold to pull out the fetus.

Are forceps used when there is a discrepancy between the size of the fetal head and the size of the pelvis, using force to compress the head?

No, obstetric forceps are not intended for this. But in any case, when using forceps, increased pressure occurs on the fetal head, and it contracts slightly.

Indications for use

Obstetric forceps are used in obstetric practice in all cases when the expulsion forces of the mother are not enough to bring the fetus to the surface.

Also, the use of forceps is justified when during childbirth there is a threat to the life/health of the mother/child and the only way out is to quickly complete the birth using forceps.

So, when obstetricians use forceps:

Remember! A narrow pelvis is not an indication for the use of obstetric forceps!

Contraindications

Successful operation

Successful delivery using obstetric forceps is possible if the following conditions are met:

Disadvantages of use

Obstetric forceps I Obstetric forceps

Application of A. shch. carried out with the aim of quickly ending labor in the interests of the woman in labor and (or) the fetus when fetal hypoxia has begun, complications of pregnancy (severe, preeclampsia), weakness of labor during the period of expulsion of the fetus, extragenital diseases of the woman that require switching off pushing (high myopia, etc. .).

The operation can be performed only if the fetus is alive and full-term, the size of the woman's pelvis and the fetal head correspond, the uterine os is fully dilated, the fetal head is in the pelvic cavity or at the exit from it, and there is no amniotic sac. Applies A. shch. obstetrician-gynecologist. Women in labor are first tested with four fingers (the thumb remains outside the genital slit) in order to determine the degree of opening of the uterine pharynx, the state of the amniotic sac, the position of the sagittal suture and the fontanelles of the fetal head. The operation is performed with the woman in the supine position in a gynecological chair, on the operating table or on a Rakhmanov bed; The mother's legs should be bent at the hip joints and spread apart (held with a leg holder). Before the operation, they are emptied using a catheter, and the external genitalia are toileted. When applying A. shch. inhalation or intravenous is used; conduction ischiorectal is possible. Depending on which part of the small pelvis (at the outlet or in the cavity) the fetal head is located, a distinction is made between output (typical) and abdominal (atypical) A. sch.

Exit obstetric forceps are more often used for the anterior view of the occipital presentation of the fetus. They are applied in the transverse dimension of the pelvis and on the transverse (biparietal) dimension of the head. In order not to make a mistake in choosing a spoon of forceps, before inserting them, fold them so that the left spoon (there is a lock on its handle) lies under the right one; the handle of the left spoon should be in the left hand, the right - in the right hand ( rice. 1 ). The left spoon is always introduced first. It is taken with the left hand, held like a bow and inserted into the genital slit on the left side; Before inserting the left spoon, to control and protect the soft tissues, four fingers of the right (control) hand are inserted so that they extend beyond the parietal tubercles of the fetal head ( rice. 2, a ). The forward movement of the spoon of the tongs should be carried out mainly due to the force of its gravity; the thumb of the right hand located on the outside slightly pushes the lower spoon. With the remaining fingers of the right hand, inserted inside, the spoon of the pincers is directed forward so that it rests on the side of the fetal head, in the plane of the transverse dimension of the pelvic outlet. The correct position of the inserted spoon in the pelvis can be judged by the Bush hooks on the handle of the forceps: they must stand strictly in the transverse dimension of the exit from the pelvis. The spoon must certainly go beyond the ends of the fingers of the control hand, i.e. for the fetal heads. The handle of the inserted left spoon is passed to an assistant, who must hold it in this position. Any kind of displacement of a correctly applied spoon can lead to complications in the future. Right spoon A. shch. inserted into the genital opening on the right with the right hand under the protection of the fingers of the left hand inserted into the vagina ( rice. 2, b ). The right spoon of the tongs should always lie on the left. After inserting the right spoon, close ( rice. 2, in ). In this case, you need to check whether the lock has gotten into the perineum or vagina. For proper closure, the handles of the spoons must lie in the same plane and parallel. The correctness of the forceps is checked using test traction. To do this, the left hand should be placed on the right, which grasps the handles of the tongs from above; the extended index finger of the left hand should be in contact with the fetal head in the area of ​​the small fontanel ( rice. 2, g ). During traction, the fetal head should follow the forceps and the index finger of the left hand.

To extract the head with the right hand, located on the handle and in the area of ​​the Bush hooks, energetic attractions (actual traction) are carried out; in this case, the left one should be at the bottom, and her index finger should be in the recess located near the lock ( rice. 2, d ). In this position, the left hand provides energetic assistance to the right during traction. together with the fetal head during traction, they must move along the wire line of the pelvis. You can't make any rocking, rotating, or pendulum-like movements. When removing the head with obstetric forceps, it is necessary to alternate tractions with pauses, as happens during contractions. Each traction begins slowly, gradually increasing its strength and, having reached a maximum, reduces the traction force, going into a pause. The pauses should be long enough. Traction along the arc is done until the suboccipital fossa appears and reaches the lower edge of the pubic symphysis. Then an episiotomy is performed (see Perineotomy) and the head is removed. More often, before removing the fetal head, the forceps are removed - first, they are carefully opened, the spoons are moved apart, then each spoon is taken in the same hand and removed in the same way as they were applied, but in the reverse order (the spoons should slide smoothly, without jerking). After removing the forceps, the head and fetus are removed according to the general rules (see Childbirth). Sometimes the fetal head is removed using forceps. To do this, the obstetrician stands to the right of the woman in labor, grabs the forceps with his left hand, and protects with his right. Carefully, very slowly, slightly pulling the head with forceps, he lifts the handle of the forceps anteriorly and straightens the fetal head. After removing the head, the forceps are removed, and the fetal body is removed according to the general rules.

Cavity A. shch. placed on the fetal head, which is located in a narrow, less often in a wide, part of the pelvic cavity. In the forceps, the head must complete internal rotation (rotation), cutting and cutting. When the sagittal suture of the head is located in one of the oblique dimensions of the pelvis, forceps are applied in the opposite oblique dimension. In this case, one spoon is inserted behind the head and left here (posterior, or fixed, spoon); another spoon is inserted from behind or from the side, and then it is turned obliquely in an arc of 90° or 45°, respectively, so that it lands on the parietal tubercle lying in front (the so-called vagus spoon). If the sagittal is located in the right oblique dimension of the pelvis, the left spoon will be fixed; if it is located in the left oblique dimension, the right one will be fixed. Tractions are performed along the wire line of the pelvis - obliquely posteriorly, downward and anteriorly (in relation to the woman in labor).

When applying A. sch, ruptures of the cervix, vagina, vulva, and perineum often occur, therefore, after the operation, it is necessary to carefully examine the soft ones and suture the ruptures (see Childbirth, labor). As a result of applying A. shch. may occur in the fetus (see Birth trauma of newborns (Birth trauma of newborns)): skin, depression of the skull bones, facial nerve, intracranial, etc. After discharge from the hospital, the woman should be observed by an obstetrician-gynecologist at the antenatal clinic or a midwife at a medical and obstetric station (see Postoperative period, features of outpatient management of patients after gynecological and obstetric operations), a child - a pediatrician and a neurologist.

Bibliography: Bodyazhina V.I., Zhmakin K.N. and Kiryushchenkov A.P. , With. 447, M., 1986; Golota V.Ya., Radzyansky V.E. and Sotnik G.T. Obstetric forceps and vacuum extraction of the fetus, Kyiv, 1985; Malinovsky M.S. Operational, M., 1967.

an obstetric delivery operation in which a live fetus is removed from the birth canal using a special instrument.

Atypical obstetric forceps(A. shch. cavitary) - A. shch., in which the instrument is applied to the fetal head, which has not completed the internal rotation and is located in the pelvic cavity.

High obstetric forceps- A. shch., in which the instrument is applied to the fetal head, which has not yet descended into the small one.

Obstetric forceps weekend- see Typical obstetric forceps.

Abdominal obstetric forceps- see Atypical obstetric forceps.

Typical obstetric forceps(syn. A. sch. weekend) - A. sch., in which the instrument is applied to the fetal head, which has completed the internal rotation and is located at the outlet of the small pelvis.