FORCEPS

EXTRACTION

BATASAN
Tindakan obstetrik yang bertujuan untuk
mempercepat kala pengeluaran dengan
menarik kepala janin dengan alat forceps

INDIKASI
Indikasi ibu:

Penyakit jantung
Edema paru
Infeksi intrapartum
Kelelahan ibu
Ibu yang tidak bisa meneran secara efektif atau
ibu tidak boleh meneran

INDIKASI (LANJUTAN)
Indikasi janin:

Tali pusat membumbung kala II

Gawat janin kala II

Indikasi waktu:

Perpanjangan kala II (>1 jam) pada presentasi

kepala

SYARAT
Kepala sudah turun samapai station>+2
Presentasi belakang kepala atau presentasi
muka dengan dagu di depan

Pembukaan lengkap
Ketuban sudah pecah atau dipecahkan
Tidak ada disproporsi kepala panggul
Kontraksi uterus baik
Ibu tidak gelisah/ kooperatif
Kepala dapat terpegang oleh daun forceps

KRITERIA EKSTRAKSI FORCEPS

GAGAL
Tidak bisa dipasang
Tarikan dirasakan berat

Bila ekstraksi forceps gagal, persalinan diakhiri

dengan seksio sesarea

of Fetus
OBSTETRICAL
For Extraction

FORCEPS

TYPES OF FORCEPS

Simpson forceps
Tucker McLane forceps
Kielland forceps
Naegle forceps

TYPES OF FORCEPS
TUCKER MCLANE

TYPES OF FORCEPS KIELLAND

TYPES OF FORCEPS - SIMPSON

PARTS OF FORCEPS - NAEGLE

BLADES CURVE

C
L
A
S
S
I
F
I
C
A
T
I

FUNCTION OF FORCEPS

TRACTION and/or ROTATION fetal skull

Remember. !!
Excessive force may damage fetal skull

INDICATION OF FORCEPS

Any condition threatening mother

and fetus that can be relieved by delivery

INDICATION OF FORCEPS
Mother condition(s), could be.

Heart disease
Pulmonary injury / compromise
Intrapartum infection
Certain neurological condition
Exhaustion
Prolonged second stage labor

INDICATION OF FORCEPS
Fetus condition(s), could be.

Prolapse of umbilical cord

Premature separation of placenta
Nonreassuring fetal heart pattern

PREREQUISITES FOR
FORCEPS APPLICATION

The head must be engaged

Position of head precisely known

Fetus present as a vertex or by the face chin

anterior
Cervix completely dilated
Membrane ruptured

No cephalopelvic disproportions !!

PREPARATION OF FORCEPS
DELIVERY
Patient preparation

Emptied bladder (catheterization)

Lithotomy position
Analgesia as necessary

FORCEPS APPLICATION

The head of fetus is perfecly grasped only

when the long axis of the blades correspond
to the occipitomental diameter

FORCEPS APPLICATION

FORCEPS APPLICATION
Applied on occipitomental diameter (biparietal).

Head is perfectly grasp

Forceps should not slip

When applied obliquely.

Grasp less secure, forceps cannot be locked

Fetal head exposed to injurious pressure

FORCEPS APPLICATION

FORCEPS APPLICATION

FORCEPS APPLICATION

FORCEPS APPLICATION

FORCEPS APPLICATION

APPROPRIATENESS OF
APPLICATION
Check application before traction is applied

Occiput anterior position applied blades are

equidistant from the sagittal suture

Occiput posterior position blades are

equidistant fom the midline of face and brow

No grasping on cervix !!

OUTLET FORCEPS
OPERATION

TRACTION

Be certain blades satisfactory placed

Horizontal traction until perineum begin to bulge,

gradually elevated as parietal bone emerge

Episiotomy if indicated

Intermittent, apply traction with each uterine

contraction

Be Gentle !!

TRACTION - HORIZONTAL

TRACTION - VERTICAL

TRACTION

TRACTION

COMPLETION OF DELIVERY
After vulva well distended by the head and the
brow can be felt through the perineum.

Keep forceps in place upward traction (may

need large episiotomy)

Or

Forceps removed and delivery completed by

modified Ritgen maneuver (slowly extending
head by using upward pressure upon the chin)

COMPLETION OF DELIVERY

COMPLETION OF DELIVERY

LOW & MID FORCEPS

OPERATION

LEFT OCCIPUT ANTERIOR

POSITION
1. Right hand to left post segement of vagina
identify posteriorly located ear & as guide
for introduction of left branch of the forceps

2. Two fingers of left hand right post portion

of pelvis, as guide for introduction of right
branch

RIGHT OCCIPUT ANTERIOR

POSITION
1.

Left hand to right post segement of vagina

identify posteriorly located ear & as guide for
introduction of right branch of the forceps

2.

Two fingers of right hand left post portion of

pelvis, as guide for introduction of left branch

OCCIPUT TRANSVERSE
POSITION

First blade applied over the posterior ear

and the second rotated anteriorly to a
position opposite the first

In this case, one blade lies in front of the

sacrum and the other behind the
symphysis

OCCIPUT POSTERIOR POSITION

Try manual rotation first.
Insert hand and grasp fetal head at its sides.

For Right Posterior Position use left hand to

rotate the occiput anteriorly clockwise

For Left Posterior Position use right hand to

rotate the occiput anteriorly anticlockwise

OCCIPUT POSTERIOR POSITION

OCCIPUT POSTERIOR POSITION

Manual rotation fails., apply blades and deliver
from occiput posterior position

1.

Horizontal traction base of nose under

symphysis (episiotomy performed)

2.

Then elevates slowly occiput gradually

emerges ove the perineum

3.

Then, imparting downward motion to the

instrument nose, face, chin emerge

OCCIPUT POSTERIOR POSITION

FACE PRESENTATION

1.

Downward traction is exerted until the chin

appears under the symphysis

2.

Then, by an upward movement, the face is

slowly extracted

FACE PRESENTATION

TERIMA KASIH