AIIMS November 2011 – MCQ 18

All are inaccurate regarding forceps delivery except?
A. The sagittal suture should not be more than 15 degrees to the anteroposterior diameter of pelvis
B. The presentation should be vertex or mentoanterior
C. The presenting part should be at at zero station
D. Caput succedaneum is a contraindication

Correct answer : C. The presenting part should be at at zero station

The question can be rewritten as : Which is true regarding forceps delivery?
Option A is false – Kielland forceps is used in deep transverse arrest – the sagittal suture will be at 90 degrees to anteroposterior diameter of pelvis
Option B is false – Forceps can be used for breech delivery
Option C is true – Refer prerequisites for forceps application given below
Option D is false – Caput succedaneum is not a contraindication

Prerequisites for Forceps application (Mudaliar, 10th, p327)
-There should be a proper indication
-The cervix must be fully dilated and taken up
-The membranes must be ruptured
-The presentation should be vertex, face or the aftercoming head in a breech case
–The greatest diameter of the head should have passed through the brim of the pelvis and there must be no disproportion between the fetal head and the pelvis anywhere in the cavity or outlet. No part of the fetal head should be paplable per abdomen
-The position of the head should be ascertained by palpation of the fontanelles and sagittal suture
-Analgesia should be satisfactory
-The uterus must be contracting and relaxing
-The bladder and rectum should be empty
-Informed consent should be obtained from the patient

Contraindications for forceps delivery (Obstetrics and Gynaecology By Sarabatnam Arulkumaran, Lesley Regan, Aris Papageorghiou, David Farquharson, Ash Monga – Google books)
-Incompletely dilated cervix
-Unknown fetal position
–Station above ischial spines
-Operator is inexperienced in forceps delivery
-Clinical cephalopelvic disproportion