Obstetric forcefs sermons

2021-03-20 12:00 AM

Forcefs consists of two separate branches called left and right branches and called left or right branches depending on whether they will be placed on the left or right branches of the mother.

General perception

The Forcefs is an obstetric device that holds the head of the fetus firmly to pull the fetus out in a nearly natural mechanism, just like the mechanism of labor: forward or backward, bow or back, write down or book, help end labor quickly, protect the rights of mother and fetus.

Forcefs was born from about the seventeenth century to the middle of the nineteenth century. There have been important improvements in structure and trickery practices to reduce the risk of using forcefs. In the late nineteenth and early twentieth centuries, significant progress was made in the use of forcefs, the designation of forcefs became more widespread to deal with difficult births, and complications for both mother and baby also occurred. .

In the mid-twentieth century, with the development of resuscitation anaesthesia and the generation of antibiotics, extensive caesarean surgery and aspirations, forcefs use increasingly narrowed with certain indications. .

Tool description

Forcefs consists of two separate branches called left and right branches and called left or right branches depending on whether it will be placed on the left or right branches of the mother. The two branches are matched by a key. The lock can be a slide lock (Kjelland) or a cross lock (Simpson) or a screw lock (Tarnier), or the two branches do not match, but only use the horizontal pin (Suzor). Each branch consists of 3 parts: handle body and spoon. The spoon may have windows or may not be a fake window. Each forcefs has two main curvatures: head curvature and pelvic curvature, which correspond to the curvature of the fetal head and the curvature of the pelvis. Thanks to these two curves it is possible to direct forcefs when used. Depending on the type of forcefs these curvature changes (more or less curvature). In addition to the above two curvatures, there may also be epistallic curvature for some types of forcefs (Piper, Tarnier).

Depending on the structure, it is divided into many different categories, but it can be divided into two main categories: the classic forcefs group like Simpson forcefs ... and specialized forcefs such as forcefs Kjelland, Barton, Piper, Suzor.

Effect of forcefs

The effect of forcefs is to pair and pull the head of the fetus without causing trauma while ensuring normal physiological movements. That is why the forcefs - a holder is not only considered a traction device but also helps to turn the head, allowing the head to bow and tilt. The lower fetus requires pairing and pulling.


The best and ideal pair is when the forcefs both secures the fetus and protects it without risking the fetus or mother. Depending on the type of person, we have different pairs.

Pair in the cap: there are two ways of pairing :

The symmetrical pair is the ideal pair, usually, the fetus has a good bow with two spoons holding two top humps, following the occipital diameter of the chin, one at the front of the arm, one at the end of the eye. The spoon window corresponds to the top bone and cheekbones, the base of the spoon at the occipital and the tip of the spoon above the chin.

Asymmetrical pair: a spoon above the brow bone, a spoon above the cymbals, also known as the cymbals, but this type is dangerous for the fetus because of damage to the eyes, often the pair is for the left-crown. or transverse position in the right apex.

Pair of faces :

The pair is symmetrical according to the diameter of the occipital chin, the tip of the spoon on the occipital, the base of the spoon on the chin.

The pair star in the e reverse your cost- Weather :

Also in the occipital fashion. While the couple should pay attention to protect the mother. The best defense is that the curvature of the forcefs branch should be parallel to the sacrum, truncate, ie the corner of the subframe axis. The bigger the spoon is, the better it is for the fetus, but for the mother, the more dangerous and vulnerable to soft tissue damage.


Pulling is best to involve the mechanism of birth, that is to follow the downward and downward mechanism of the fetus. This will be less dangerous for the mother and fetus. If the throne has passed but is still high, it must be dragged along the leap axis of the throne, that is, dragged towards the feet of the midwife.

If the throne has passed, it is followed by the window, without the need for the direction of the pelvic and perineal curvature.

Currently, only forcefs are used in the low or at least average cymb. The pulling technique must pull evenly, slowly, right along the downward and downward axis. Must pull with the strength of the forearm muscles, absolutely not pull with the strength of the whole body.

Other effects of forcefs

In addition to the two main effects of pairing and pulling, it was previously thought to have other effects such as rotating, bending, back and tilt.

Rotation: Of the 3 moves the spin is the one that requires the most forcefs. For the cusp there are two types of registers, namely occipital and occipital, but the same number of dots is better so people often return to the occipital. With a face that has only one pride, it is only possible to turn to the chin so it will have to rotate 45 ° or 135 °.

The basic rule of thumb for forcefs to rotate around its axis is in line with reincarnation. Thus the forcefs roll has to spin a very wide rotation. If the spoon rotates along the axis of the forcefs handle, meaning that the handle is turned in a wrench, the spoon will rotate very wide and cause extensive damage to the mother. Have to pull the head down, let it rest on top of the pupil, then the forces hilt up, then rotate from top to bottom.

Bow or back: in the crown and the face is usually very arrogant, so it is difficult to bow or face-up, so even if the throne falls, it is difficult to dial down. To do this, when the forcefs are placed, the spoon must stick firmly to the reincarnation so that when the spoon is lowered, the head will bow or return.

Tilt: only until the book, when the two apical bumps have come close to the vulva, the tilting movement will help each goitre one in turn. This is done at the same time as the forcefs branch is removed.

Conditions do forcefs

To do forcefs without harming the fetus and mother, one must comply with the following conditions:

Pregnancy must live: a live pregnancy is an inevitable condition. If the fetus is dead, the abortion must be terminated because forcefs can cause unnecessary injury to the mother.

The throne must be medium or low.

Must be a throne capable of giving birth to the lower line: the crown must be the crown, the front chin or the posterior face in the buttock.

There is no mismatch between the fetus and the pelvis.

The cervix must be completely open.

Oh, broken.

The bladder and rectum must be empty.

Specifies forcefs

Designation on the mother's side

The mother pushes not to move: this is the classic option that makes up the majority of cases with the forcefs designation.

The threat of rupture of the uterus, a leap of the throne, it should be noted that if the uterus is suspected, a caesarean section is required, not forcefs.

The uterus has scarring of old fetal tissue, after the forcefs is done, the uterus must be controlled.

The mother of medical diseases: including respiratory diseases (bronchial asthma, tuberculosis ...), cardiovascular disease (hypertension, heart valve disease, heart failure ...) forcefs in this case to avoid the exertion of the mother that can affect the pregnant woman's life.

Syndrome of eclampsia, pre-eclampsia.

Endocrine diseases: Basedovv, diabetes mellitus.

Designation on the child side

Pregnancy failure (or fluctuations in the fetal heart). However, keep in mind that when reincarnated into the subframe, the fetal heart is usually slow because the reincarnation is forced into the pelvis.

The fetus is not bowed well or has a bad head.

The star stops rotating in the horizontal position or the post position.

Technique put forcefs

In the forcefs technique, there are two important issues: preparation and official forcefs. Good preparation, it can limit errors and ensure safety for mothers and children.


Prepare your pregnant woman before the procedure :

It is important to explain to pregnant women and families why forcefs is required and why forcefs must be done.

The woman is in a gynaecological position with her buttocks touching the edge of the table.


Shave pubic hair.

Disinfect the vulva, vagina, aseptic spread as in surgery.


Pain relief for pregnant women.

Arouses nerve reflexes and pain relief for pregnant women. Should mild anaesthesia or epidural anaesthesia, it is necessary to ensure that the perineal has been relieved enough if not need to supplement with local anaesthesia where the episiotomy will be removed. If the throne is low, the pregnant woman cooperates, maybe just anaesthesia at the epithelium in the inferior nerve and anaesthesia where the episiotomy will be removed.

What the wizard needs to do before placing forcefs :

Report to the anesthesiologist if necessary anaesthesia is necessary.

Report to neonatologist such as pregnancy failure, preterm pregnancy.

Hand washing, antiseptic like in surgery,

Wearing a shirt, a hat, and stitching.

Redefine potential, type, permeability, and forcefs conditions.

Choose the right tools for permeability, posture and operator habits.

Tool preparation :

A table that has available forcefs, episiotomy, clamps, gauze, needle thread is required. ..

Newborn resuscitation tools and facilities.

Technique put forcefs

When applying forcefs, it is necessary to be calm, not in a hurry, and the fetus can tolerate hypoxia better than suffering from trauma.

Then 1:

One final examination of the position of the star, looking for the lobes, joint grooves.

Again redefine the set conditions, if a new condition is set.

Then 2:

Place two forcefs branches: the first branch should be the posterior branch, that is, the branch in the apex because it is the widest place. Put your whole hand or 4 fingers in the vagina to find the landmarks and ears of the fetus and the direction for the forcefs spoon, ideally placed in the occipital direction, over the hump to the cheeks and chin, taking care not to put the forcefs in. uterus and vagina. There are three ways of holding forcefs branches:

Hold the handle like a dagger.

Holding like "acê s" of the violin.

Hold the handle like a pen.

With the branch at an angle of the vulva, insert the spoon with the hand towards the base of the spoon at eye level. Once the first branch is placed, give it to the assistant to keep the forcefs branch from changing its position. That set the second branch, ie the first branch, is usually easier. With 4 or 2 fingers point the second branch into position so it can match the first branch. If you find it difficult to match the branches, you must pull out and replace, you should not try to joint the branches because this can cause trauma to the fetus. Absolutely not change the position of the first branch.

For those falling diagonally from the left, place the left branch first, for those falling diagonally right, put the right branch first.

Then 3:

Verify that the placement meets the requirements: set the intended style through the mould matches, not put in the software, the branches are not channelling.

Then 4:

Matching and pulling: fit two branches together then install the puller (if forcefs Tarnier), install the horizontal pin (if forcefs Suzor) ... depending on the type of forcefs. The boom should be pulled slowly by the force of the handcuffs along the axis of the delivery tube.

Then 5:

Unscrew and remove the branch.

When the head has reached the vulva, the two apical humps are about to go, take turns removing the pin screw and removing the branch, taking the right branch first, stroking the branch in the direction of the head's curvature in order not to cause trauma and to sple out each apical hump. , then let the fetus take out as normal delivery.

About episiotomy is a routine practice, systematic ablation of the episiotomy when forcefs of the following types of surrogacy or human comparison. an episiotomy is best when the episiotomy is stretched and pulled horizontally towards the sitting mound.

After the pregnancy book, the vegetable book should check to see if there is trauma, check the cervix, vagina, vulva, to prevent and miss soft lesions that cause prolonged bleeding.

Placing each specific type of th ế

Satellites: the simplest and easiest place

Then 1:

Examination and examination showed that the bipolar joint line was vertical. The posterior cavity and occipital bone lie just below the hip joint.

Then 2:

Place the forcefs branch with two fingers on the left side of the vulva to gradually guide the forcefs spoon in, the left-hand holds the left branch after rubbing the spoon on the back of the spoon, levelling with the posterior edge of the vulva at 5 o'clock, the tip of the spoon press down on the right palm slowly

Hold the spoon to the tip of the spoon to the 3 o'clock position while the assistant keeps the branch in place, put the right branch at 7 o'clock and slowly lower the handle down to the tip at 9 o'clock. Both spoons should be pressed against the hump, cheeks, and chin.

Occipital same

Then 1:

Examination of the bipolar groove in the middle, posterior taper and posterior occipital bone, two parietal bones on both sides, the fetal face behind the pubic joint.

Then 2:

Placing two forcefs stems, positioned in an occipital position but is more difficult because the fetal occipital obstructs the entrance of the two spoons. The pelvic direction will be in the direction of the fetus.

Thi 3:

Check the forcefs branch again.

Then 4:

Match the two spoons together and pull.

There are two ways to pull: or pull with occipital while having cut the episiotomy on both sides, pull until the base of the nose resting on the pubic joint, lift the handle to slowly count the anterior lobe, then the posterior one, wait for the posterior to press on. the sacral then lowered to allow the face to continue; or 180 ° rotation: to rotate the handle of forcefs branch along the axis of the spoon, after turning it into a pubic dot, then remove and re-set in the style of mu. Often difficult.

Then 5:

Remove and re-examine the cervix of the epithelium because it is easily torn.

Occipital in sub-frame

When the throne has fallen on average, not yet deep, and not yet rotated, there are usually the following stars and types:

The left front of the pot:

Then 1: Examination that the bipolar joint line is located along the left diagonal of the mother, posterior to the left pelvis.

Then 2: Put forcefs spike.

Place the left branch first, place the right palm at 5 o'clock, behind the left side of the pregnant woman's vagina, and fix the left branch there. Place the right branch according to the left-hand palm at 7 o'clock and then rotate the spoon half a turn from bottom to top to a symmetrical position with the left spoon at 10 o'clock.

Then 3: Check that the location is correct, experience when placing branches 2 is always more difficult.

Then 4: Match the branches and pull down to the perineal layer, rotate 45 ° in a counter-clockwise direction so that the throne turns to the occipital and then pulls straight.

Then 5: Remove that branch to check the fetus and mother.

Pelvic right after:

Then 1: Examining the bipolar groove corresponding to the left diagonal diameter of the mother, posterior at the 7-8 o'clock position.

Then 2: Put the forcefs, put the left spoon first, set it at 5 o'clock, the right spoon set after, set at 10 o'clock, the second spoon is more difficult.

Then 3: Check the placement.

Then 4: Join the branches to pull, pull the occipital down to stretch the episiotomy, rotate clockwise (135 °) to turn into pubic. After spinning, the two forcefs will face down, so they must be removed to put back in the occipital fashion.

Then 5: Remove the branch, then support the pregnancy and check the fetus and the mother again.

Urinate right before and occipital left after:

In these two types, the dipole is located along the right diagonal diameter. The branch first is the right branch, then the left branch. When the two branches are matched together, the right branch must be raised upwards and the left branch down, so it is often difficult and easy to trauma for the child.

Pelvic occipital right horizontal and lateral left pelvis:

Two spoons must be installed in the occipital asymmetrical position. For the right pot lukewarm, place the left the spoon in front of the right spoon after. As for the left side pots, place the right spoon in front of the left lateral spoon. If the pattern has turned first, it must be set like that first whether placing the left occipital or horizontal occipital all rotated 90 ° to turn into pubic.

Other stars

The face

Front chin: relatively easy to install and install forcefs. After the installation is complete, push the palate down so that the head is tilted well before pulling, so it will be down and pockmarked easily.

Hind chin: only put forcefs when it is easy and the baby is small, before pulling right back to chin first and then proceed as above. It is theoretically in fact that the posterior chin can not be born.

Invert head

The Bratch or Mauriceau procedure is used to get the head of the tail. If you have used this method but failed, you must use forcefs, then it is difficult to get the tail. This is just a case of disguised abortion. Currently, there is a view that forcefs should not be done, but the caesarean section is recommended when the posterior position is posterior.

If the situation requires forcefs:

Cut the episiotomy first.

Doing tricks Mauriceau first for his head to return to the satellites.

Hold the fetal legs up and give them to the woman to hold.

Put forcefs, place left branch in front of the right branch after then match two branches.

Don't remove forcefs in the beginning of the window, but use forcefs at the beginning of the window slowly.


Injury to the mother

Genital tract injuries :

Tearing of the episiotomy, vulva, and sacrum is especially difficult in such a difficult position.

Tearing of the cervix.

Broken uterus.

The leak of the bladder rectum.

Pubic joint dilatation.



The consequences can lead to maternal death if not handled well.

Injury to the fetus

Head hematoma: due to sub peritoneal hematoma. The hematoma will go away on its own in a few weeks.

Eye damage: conjunctival bleeding, eyelid abrasion, bulging eyes.

Broken skull:

Skull fracture without bone subsidence will go away naturally.

Broken fresh branch skull bone with subsidence requires scanning to find subdural hematoma or bruise on the brain. Although small osteomalacia may go away spontaneously, surgery can be done in the first week of the day.

Bleeding in the skull:

Posterior fossa hematoma appears after a 12-hour latent period, possibly after 5 to 8 days. Based on nonspecific signs: weak crying, decreased muscle tone or increased muscle tone, fibrillation of the eyeballs, convulsions, cranial nerve paralysis, bulging fontanelle, increased head circumference, irregular breathing, apnea, bradycardia, arrhythmia.

Epidural hematoma: caused by damage to the middle meningeal artery or the large venous sinus due to rupture of the temporal bone.

Symptoms of increased muscle tone, bulging fontanelle, thoracic ultrasound or Scanner help diagnose. Surgical treatment.

Subdural hematoma: Subdural hematoma in the temporal region asymptomatic or manifested by convulsions accompanied by focal nerve signs. Hematoma in the cerebral basal region, cerebral stem compression, manifesting convulsions, irregular pupils, coma ... seizure by ultrasound, scanning.

Drainage treatment.

Hematoma in the brain.

Peripheral facial paralysis: nerve paralysis VII.

Bone marrow injury.


Forcefs is an essential tool in obstetrics, but the procedure can also cause a lot of damage for the mother and the fetus. So in order to ensure the safety of mothers and children, we need to:

Understand the terms and techniques of placing forcefs.

Only do forcefs when the top is medium or low.

Prepare a good mother for the pregnancy and the doctor

After the procedure, in some cases, there is an old caesarean scar that requires control of the uterus.

In other cases, it is necessary to re-examine the cervix with the same map, vagina, vulva, perineal layer.

Check the fetus.