USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

FORCEPS

Obstetric forceps are metal instruments used to provide traction, rotation, or both
to the fetal head. Classification for use is as follows:

Indications are as follows:

Prerequisites include the following:

Outlet  (most   common  forceps use):   fetal   head    is  on  pelvic  floor

Low:    fetal   head    is  below   +2  station but has not reached the pelvic  floor

Mid (seldom used    today): fetal   head    is  below   0   station but has not reached +2

station

High    (never  appropriate in  modern  obstetrics  because of  risk    to  both    mother

and fetus): fetal   head    is  unengaged,  above   0   station

Prolonged   second  stage   (most   common  indication  for forceps):   may be

because of  dysfunctional   labor   or  suboptimal  fetal   head    orientation

Category    III EFM strip:  fetal   heart   rate    monitor pattern suggests    fetus   is  not

tolerating  labor

Avoid   maternal    pushing:    include various conditions  in  which   pushing efforts

may be  hazardous   to  parturient, e.g.,   cardiac,    pulmonary,  or  neurologic

disorders

Breech  presentation:   shorten the time    to  deliver the head    of  a   vaginal breech

fetus

Clinically  adequate    pelvic  dimensions