New Assessment of Fetal Descent and Forceps Delivery

This book offers a highly informative guide to forceps devices and delivery techniques. Extensive figures and animations offer readers vivid insights into the fetus station, pelvis, and inserted forceps. The book covers normal presentation and abnormal rotation, presentation and attitudes, and especially focuses on the assessment of fetal descent. It discusses the problem with conventional fetal station, and explains the revised one based on the trapezoidal plane.
Instrumental delivery is chosen in cases of worrisome fetal status, protracted labor, or maternal fatigue. Forceps can provides a greater pulling power than vacuum extraction, and the fetus can be delivered in a short time, though this technique calls for experience and technical proficiency. The book argues that in order to ensure safe and reliable forceps delivery, assessment of the fetal station and the site of the largest fetal head circumference is critical.
The book offers a new and indispensable reference guide for all obstetricians, not only for residents, but also for all experienced professionals involved in the training of beginners, and even for those using vacuum extraction who would like to assess the fetus more objective and practically.

• Language: English
• Publisher: Springer
• Release date: Apr 4, 2018
• ISBN: 9789811047350

Book preview

Editor

Satoru Takeda

New Assessment of Fetal Descent and Forceps Delivery

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Editor

Satoru Takeda

Distinguished Professor Obstetric and Gynecology, Juntendo University, Tokyo, Japan

ISBN 978-981-10-4734-3e-ISBN 978-981-10-4735-0

https://doi.org/10.1007/978-981-10-4735-0

Library of Congress Control Number: 2017955690

© Springer Science+Business Media Singapore 2018

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Preface

Forceps delivery and vacuum extraction delivery cases account for 5–15% of all deliveries. Forceps and vacuum extraction are used to avoid maternal and fetal crises in the second stage of labor, serving as essential tools for obstetricians. Although vacuum extraction delivery is the major procedure, lawsuits over vacuum extraction delivery continue, and far more cases of vacuum extraction delivery than forceps delivery are addressed by the Japan Obstetric Compensation System Cause Analysis Committee. The reasons for this may include the following: multiple attempts at vacuum extraction despite poor fetal condition which prolongs labor and results in deterioration and weak traction force necessitating combined use of the Kristeller maneuver for expulsion of the fetus, resulting in deterioration of the fetal state. In addition, in vacuum extraction delivery cases, trial traction may, unlike forceps delivery, be performed even when the fetus is in a relatively high position, and traction may again be performed if the fetal head descends. The forceps procedure involves no concept of carrying out a trial; this procedure cannot be performed unless the fetal head is in the proper position for forceps delivery. Therefore, the fetal head descent must be assessed accurately, and if the proper position for forceps delivery is not achieved, there is no choice but to perform cesarean section. Implementation of forceps delivery requires a good understanding of the processes of normal labor, good pelvic examination skills for assessing the fetal head position, and acquisition of the proper technique.

Although we have consistently provided instruction on the forceps procedure alone, we have attached the highest importance to the capability of the doctor to accurately perform pelvic examination, estimate the site of the largest fetal head circumference, explain these findings, and share the information on cases with other doctors in case conferences, rather than focusing on the forceps techniques themselves. Because the forceps procedure involves no concept of a so-called trial run or practice attempts to assess the feasibility of delivery, the forceps procedure cannot be performed without accurate pelvic examination. Therefore, the goal of education is to master the site of the descending fetal head that allows safe and secure forceps delivery. To this end, we provide education about accurate assessment of the fetal head descent by means of important points of pelvic examination including the angle of the posterior surface of the pubic symphysis and the palpable extent, using a new concept, the t-station, based on the pelvic axis rather than the conventional concept of DeLee’s station, in order to obtain more objective and practical pelvic examination findings.

This book describes new techniques for pelvic examination and the forceps procedure, but we believe that this book is also useful for doctors who perform vacuum extraction delivery. We would encourage readers to use this book as a reference and would appreciate any comments from practitioners considering and applying the information provided.

Satoru TakedaDistinguished Professor

Contents

New Concept of Fetal Station Based on the Trapezoidal Plane (T-Station) 1

Satoru Takeda

Properties and Characteristics of Forceps Delivery 9

Hiroyuki Seki and Satoru Takeda

Techniques for the Forceps Procedure 15

Jun Takeda and Satoru Takeda

UTokyo Kielland Forceps 29

Shintaro Makino, Jun Takeda and Satoru Takeda

Education 37

Atsuo Itakura

© Springer Science+Business Media Singapore 2018

Satoru Takeda (ed.)New Assessment of Fetal Descent and Forceps Deliveryhttps://doi.org/10.1007/978-981-10-4735-0_1

New Concept of Fetal Station Based on the Trapezoidal Plane (T-Station)

Satoru Takeda¹  

(1)

Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan

Satoru Takeda

Email: [e-mail]

Electronic Supplementary Material

The online version of this chapter (https://​doi.​org/​10.​1007/​978-981-10-4735-0_​1) contains supplementary material, which is available to authorized users.

Proper Positions for Vacuum Extraction and Forceps Delivery

To perform vacuum extraction or forceps delivery, it is most important to estimate beforehand where in the pelvis the leading portion of the fetal head and the site of the largest fetal head circumference are located. These are decisive factors for judging whether the fetus is in the proper position for vacuum extraction or forceps delivery. If the position of the fetal head is incorrectly estimated, forceps would be used on the fetus without proper positioning for forceps delivery,