Forceps

Forceps tool that replaces childbirth missing or missing power of uterine contractions. Forceps serve as continuation of the hands of the midwife ("iron hand" of a midwife).
The application of obstetrical forceps - one of the most important and responsible operations in practice obstetrician. Technical difficulties operation takes one of the first places in the operative obstetrics. When applying A. y. there are various injuries and complications.
The device obstetrical forceps - see Obstetric-gynecological tools. The most common model in the USSR are English A. y. Simpson modification N. N. Fenomenov. In some obstetric institutions apply the Russians forceps I. P. Lazarevic - without pelvic curvature (straight forceps) and with neprekrashajushiesja spoons (tongs with parallel spoons); obstetric forceps of Kelland (widely spread abroad the model) is modelled on the forceps I. P. Lazarevic.
The main action of forceps purely mechanical nature: compression head, straightening her and retrieval. Compression of the head, which is inevitable when forceps delivery should be minimal, in any case not to exceed that which is observed in childbirth in the natural configuration of the head. Otherwise, it will inevitably suffer bones, blood vessels and nerves of the head of the fruit. A. u. are only exciting and attracting tool, but not correcting incorrect presentation and inserting head.
Indications and contraindications. First of forceps superimposed on the personal discretion of the obstetrician, currently produced some indications for their application. Forceps are imposed in cases where it is necessary quickly to finish childbirth in the interests of the mother, fetus or both together: and eclampsia, premature detachment of the placenta, cord prolapse beginning of asphyxia fruit, diseases of the mother, complicating the course of the period of exile (heart diseases, nephritis), the feverish state, etc. In secondary weakness generic activities forceps are used in the cases when the period of exile in nulliparous lasts more than 2 hours. (3-4 hours), and nagaragawa - more than an hour.
It is strictly necessary to consider contraindications to the use of forceps. They are derived from the following conditions under which you can apply this operation: adequate size of the pelvis, which will guide you through the head, the true conjugate should be not less than 8 cm; the head of the fetus should be neither too high (hydrocephalus, expressed a late pregnancy)or too small (on the head of the fetus are younger than 7 months. Curling cast is impossible); the head should be in the pelvis in easy to overlay forceps position (movable head is a contraindication); the cervix should be smoothed, uterine cervix is fully disclosed, edges it should come for the head; fetal bladder must be broken; the fruit must be alive.
Among these conditions is especially important is the height of standing of the head in a basin. For practical work, you can use the following scheme of location of the head. 1. The head is above the entrance to the pelvis (Fig. 1), easy to navigate with the push is coming back (bellatorum). Forceps delivery is contraindicated. 2. Head came into the pelvis small segment (Fig. 2). Most of the circumference (biparietal diameter) is located above the entrance to the pelvis. Cervical-neck furrow stands on three cross fingers above the symphysis; head limited mobile, slightly fixed. When vaginal examination Cape available exploring finger; arrow-shaped bead - lateral or slightly oblique size of the pelvis. Forceps to impose cannot. 3. The head at the entrance to the pelvis largest segment (Fig. 3); biparietal diameter she passed the entrance to the pelvis, motionless; cervical-occipital groove is on two fingers above the symphysis. When vaginal examination Cape cannot be reached; head busy front top and the upper third of the back surface pubic joint, behind - the Cape and the inner surface of the first sacral vertebra. Arrow-shaped scar - in one of the slanting size, sometimes closer to cross. Wired point almost reaches the line of the main plane, passing through the lower edge of the symphysis. Forceps to impose, especially a beginner midwife, is not recommended (high tongs). 4. Head in the wide part of the pelvic cavity (Fig. 4); it is the largest of its circumference was the plane of the widest part of the cavity, neck and neck furrow - approximately one finger above the symphysis. When vaginal examination sciatic barb achievable, sacral depression nearly finished, Cape cannot be reached. Wired point almost reaches the spinal line, arrow-shaped scar - in an oblique size. Free felt III and IV of the sacral vertebrae and the coccyx. Forceps delivery is permitted (atypical tongs, difficult operation). 5. Head in the narrowest part of the pelvic cavity (Fig. 5); above the entrance to the pelvis she is not defined (cervical-neck furrow level with the height of the symphysis). When vaginal examination sciatic barb not defined, sacrococcygeal joint freely. Head close to the pelvic bottom, it separately size is the plane of the narrow part of the pelvic cavity. Small fontanel (wired point - the following spinal line; the head is not yet fully completed the rotation arrow-shaped scar - in one of the slanting size of the pelvis closer to direct. Tongs can be imposed. 6. Head in the output of small pelvis (Fig. 6). She and her neck and neck furrow above the entrance to the pelvis is not defined. Head graduated from internal rotation (rotation), swept the seam - in the direct output size of the pelvis. Favorable conditions for imposing forceps (typical tongs).