Anaesthesia: Pudendal block or Labio-perineal infiltration for outlet forceps.

Regional or General anaesthesia for low & mid forceps.

Episiotomy: Should be done either before application of forceps or during traction when the
perineum bulges

Complications/dangers of forceps delivery: - are mostly due to faulty technique

rather than the instrument.
Maternal Injury-.
Extension of the episiotomy involving anus & rectum or
vaginal vault.
Vaginal lacerations and cervical tear if cervix was not fully
dilated.
Post partum haemorrhage .
Due to trauma, Atonic uterus or Anaesthetisia.
Shock .
Due to blood loss, dehydration or prolonged labour.
Sepsis .
Due to improper asepsis or devitalisation of local tissues.
Anaesthetic hazards.
Delayed or long-term sequel .
Chronic low backache, genital prolapse & stress
incontinence.
Fetal-

 Asphyxia.
Trauma Intracranial haemorrhage.
Cephalic haematoma.
Facial / Brachial palsy.
Injury to the soft tissues of face & forehead.
Skull fracture
Remote-cerebral palsy.
Foetal death-around 2%.
KOMPLIKASI AKIBAT TINDAKAN FORCEPS
A. Pada Ibu
Forceps dapat digunakan untuk mempersingkat kala-dua persalinan
dengan peningkatan morbiditas pada ibu, seperti:
1. Perdarahan , akibat atonia uteri atau trauma jalan lahir
2. Trauma pada jaringan keras (pada tulang- tulang seperti fraktur
koksigis) dan trauma pada jaringan lunak (laserasi vagina sampai
robekan perineum)
3. Inkontinensia uri (retensio urin) dan alvi, karena:
- Trauma pada otot-otot dasar panggul dan persarafannya
- Trauma sfingter ani yang menyebabkan disfungsi
4. Demam (infeksi pasca persalinan) 1,2,4,7
B. Pada Janin
1. Insidensi perdarahan intrakranial, kelumpuhan saraf fasialis dan
pleksus brakialis.
2. Luka pada kulit kepala dan fraktur tulang tengkorak
3. Cedera m. sterno-kleido-mastoideus. 1 ,2 ,4
4.
5.
Pudendal or Perineal Block
6. (Fig. 6-22). This permits spontaneous, breech, low forceps, or
midforceps
7. delivery with little local pain. It is extremely safe and simple,

8. and the patient maintains her ability to cooperate during labor.

9. The infant rarely is depressed, and blood loss is minimal.
Disadvantages
include discomfort during the injection and a 5-min delay for anesthetic effect.
The two nerves to be blocked on each side of the vagina are the pudendal and
the posterior femoral cutaneous nerves.
The pudendal nerve lies near the inner aspect of the ischial spine and should be
blocked there. The posterior femoral cutaneous nerve may be injected beneath
the inferior medial border of the ischial tuberosity. The descending branches of
the ilioinguinal nerves supply the clitoral region. The perirectal zone is
innervated by the hemorrhoida nerves. The procedure for pudendal and
posterior femoral cutaneous block follows:
Develop a wheal of 0.5%1% procaine (or equivalent) at the base of each
labium majus. Perform all injections through thissite.
Palpate the ischial spines vaginally or rectally. Slowly guide a 4- or 5inch, 20- or 21-gauge spinal needle toward each spine while injecting
a small amount of procaine ahead of the advancing point. Aspirate,
and if the needle is not in a vessel, deposit 5 mL of anesthetic posterior
and lateral to the tip of each spine. This blocks the pudendal nerve.
Refill the syringe if necessary,
10.leaving the needle in place, and proceed in a similar
11.manner to anesthetize the other areas specified. Keep the needle
12.moving while injecting, and avoid the vaginal mucosa and
13.periosteum.
14.CHAPTER 6
15.COURSE AND CONDUCT OF LABOR AND DELIVERY 189
16.FIGURE 6-22. Use of needle guide (Iowa trumpet) in transvaginal
anestheticblock.
17.
18.BENSON & PERNOLLS
19.190 HANDBOOK OF OBSTETRICS AND GYNECOLOGY
20.Withdraw the needle about 3 cm and redirect it toward an ischial
21.tuberosity. Inject 3 mL near the center of each tuberosity
22.to anesthetize the inferior hemorrhoidal and lateral femoral cutaneous
23.nerves.
24.Withdraw the needle almost entirely and then slowly advance it
25.toward the symphysis pubica almost to the clitoris, keeping it
26.about 2 cm lateral to the labial fold and about 12 cm beneath the
27.skin. Inject 5 mL of procaine on each side beneath the symphysis
28.to block the ilioinguinal and genitocrural nerves. Expect prompt
29.flaccid relaxation and good anesthesia for 3060 min.

30.Although this procedure is optimal, it is far more common practice

31.today to merely anesthetize the pudendal nerve using the transvaginal
32.technique demonstrated in Figure 6-22. In this technique,
33.the ischial spine is palpated transvaginally and a guide is introduced
34.to facilitate needle placement. The guided needle is placed just
35.inferior and medial to the spine. It is then inserted _1 cm in the
36.tissue. After aspiration to ascertain that the injection will not be
37.intravascular, the pudendal nerve is blocked by deposition of 5 mL
38.of 0.5%1% procaine (or equivalent). The procedure is repeated on
39. the contralateral side.