2 outdated English references (Al) forceps delivery
3 operation name forceps operation
4 Classification of Obstetrics and Gynecology/Obstetric Surgery
5 Overview The forceps operation is an obstetric operation that uses forceps as traction or rotation force to correct the orientation of fetal head, assist the descent of fetal head and the delivery of fetus.
Tweezer technology has been used for more than 200 years. There are many kinds of forceps, mainly1Chamberlain's forceps in the 8th century (Figure 1 1.2.5 1), and the forceps spoon has only a fetal head bend. Smellie's short pliers (fig. 1 1.2.52) can be found in 175 1. The forceps spoon has fetal head bending and pelvic bending. Tal Nial's forceps (Figure 1 1.2.53, 1 1.2.54) are connected with a rod and a traction handle at the joint between the forceps spoon and the forceps handle, and are suitable for high fetal head. 19 16 The invented Kieran's forceps have no pelvic bending, and can be used to rotate and pull the fetal head when the occipital position is transverse. Piper's forceps is a kind of long-handled forceps, which is specially used for breech presentation and assisted delivery. Cesarean forceps are light and flexible, and are used to assist the delivery of fetal head during cesarean section. Simpson short bending forceps are the most commonly used forceps at present, which can pull and rotate the fetal head to assist the delivery of the fetus.
6 Structure and function of tweezers There are many kinds of tweezers, but all kinds of tweezers are composed of left and right leaves, and each leaf is divided into four parts: tweezers spoon, tweezers handle, tweezers lock and tweezers handle. The structure and function of Simpson forceps, Kieran forceps, Piper forceps and cesarean section forceps are described as follows:
(1) Simpson's forceps: There is a window hole in the middle of the forceps spoon, which can reduce the pressure on the fetal head and prevent the forceps from slipping. The inner surface of the pliers spoon is concave and the outer surface is convex, forming a fetal head bend to adapt to the shape of the fetal head. When the tweezers are laid flat, the top of the tweezers spoon is 8.0 cm higher than the tweezers neck. The pelvis is curved to adapt to the axis of the birth canal (Figure 1 1.2.55). The left-leaf pliers have a shallow concave shape at the joint between the pliers neck and the pliers handle, and the opposite part of the right-leaf pliers can just be inserted into the notch to form a free-moving pliers lock (Figure 1 1.2.56). After the left and right forceps are in place, close the handle of the forceps, the distance between the tips of the forceps is 3cm, and the widest distance between the two forceps spoons is 9cm. Tweezers are 35cm long and weigh 550g, which can be used to pull and rotate the fetal head.
(2) Kieran's forceps: suitable for occipital transverse position, high fetal head or uneven inclination. This kind of forceps has no pelvic bending, shallow fetal head bending and long forceps spoon, which is suitable for rotating fetal head. Each handle of Shuang Ye pliers has a small button (Figure 1 1.2.57), which is consistent with the front direction of pliers. When applied, the small button is in the same direction as the occipital bone of the fetal head. Clamp lock is simple and flexible. Different from the forceps lock of Simpson's forceps, the forceps lock of the left blade can be locked with any point on the tibia of the right blade (Figure 1 1.2.57), which plays a special role when the fetal head position is high or the inclination is uneven.
(3) Piper's forceps: It is a kind of forceps specially designed for breech delivery, which is characterized by small pelvic curvature of the forceps spoon, long and forward bending of the forceps handle, and lower than the forceps handle (Figure 1 1.2.58), so it is beneficial to the operation of the forceps for breech delivery.
(4) Cesarean forceps: This kind of forceps is short and light, with a total length of 27cm and a weight of 300g g, with a thin spoon, a short handle, and flexible locking forceps (Figure 1 1.2.59), which is convenient for cesarean section.
The classification of forceps-assisted delivery can be divided into three categories according to the biparietal diameter of fetal head and the position of the lowest part of pelvic bone during operation (figure11.2.510 ~11.2.438+03).
(1) The biparietal diameter of fetal head is above the pelvic entrance, and the lowest exposed bone does not reach the level of sciatic spine, so it is a high clamp.
(2) The biparietal diameter of the fetal head has passed through the pelvic entrance, but it does not exceed the level of the ischial spine, so it is a median forceps. Due to the different position of biparietal diameter of fetal head and the different difficulty of operation, median forceps can be divided into two types.
① The biparietal diameter of fetal head has passed through the pelvic entrance, but it has not reached the level of ischial spine, so it is a high-middle position forceps.
② The diameter of biparietal has reached the level of sciatic spine, but it has not exceeded the level of sciatic spine. The transverse diameter or oblique diameter of sagittal suture of fetal head in pelvic outlet plane is still low and middle pliers.
(3) The biparietal diameter has reached below the level of sciatic spine, the lowest exposed bone has reached the pelvic floor, and the sagittal suture of fetal head has been transferred to the anterior and posterior diameter of pelvic outlet, and low forceps operation was performed. ● Forceps delivery also includes export forceps delivery.
When the biparietal diameter is lower than the level of the ischial spine, the lowest part of the exposed bone first falls to the pelvic floor, and the vulva expands and bulges, or some fetal heads are used as outlet forceps.
3. Classification 1988. ACOG revised the classification method of forceps according to the position and rotation angle of fetal head.
(1) Mid-term delivery with forceps: the fetal head has been joined, and the lowest point of fetal skull is less than 2cm below the ischial spine.
(2) Low forceps delivery: the lowest point of fetal skull has reached or exceeded 2cm below the ischial spine. According to the rotation angle of fetal head, it can be divided into two types: type ⅰ: the rotation angle of fetal head ≤ 45; Type Ⅱ: The rotation angle of fetal head is greater than 45.
(3) Fetal forceps delivery: the fetal head penetrates into the pelvic floor without separation, so it can be seen that the fetal head is exposed first. The fetal head is sagittally sewn on the pelvic anteroposterior diameter, the left (right) occipital anterior diameter and the occipital posterior diameter.
High forceps and high forceps often cause serious harm to mother and fetus, and have been replaced by cesarean section. When forceps are used in low and middle position, the sagittal suture of fetal head is still on the transverse or oblique diameter of pelvis, which is more harmful to mother and fetus than low forceps operation, and requires high technical requirements and needs experienced doctors.
8 indications clamp surgery is suitable for:
1. The second stage of labor is prolonged due to persistent occipital transverse position or occipital posterior position, mild pelvic stenosis, fetal macrosomia and uterine atony.
2. Shorten the second stage of labor. Because of pregnancy complicated with heart disease, pregnancy-induced hypertension syndrome, cesarean section history, uterine scar and other reasons, it is not suitable to hold your breath during delivery.
3. Fetal distress caused by pregnancy-induced hypertension syndrome, overdue pregnancy, placental abruption, umbilical cord around neck or umbilical cord prolapse.
4. It is difficult to deliver the fetal head after the facial position is chin-front or breech position.
5. The general situation of lying-in women is not suitable for applying abdominal pressure during delivery. Such as heart disease, acute and chronic lung diseases or other diseases, severe pre-eclampsia, severe liver and kidney diseases, mental and nervous system diseases such as epilepsy and schizophrenia, maternal high fever and organ failure, hypertension, arteriosclerosis and pregnancy-induced hypertension syndrome. And patients with eclampsia or preeclampsia need to shorten the second stage of labor.
6. Suction failed, and it was confirmed that there was no obvious head-basin asymmetry or that the fetal head had entered the basin or even passed through the plane of sciatic spine.
7. breech position, forceps are needed for midwifery at the beginning and after delivery.
8. Those who have a previous history of cesarean section or have scars in the uterus and need to shorten the second stage of labor.
9 contraindications 1. Pelvic stenosis or disproportion of head and basin. The biparietal diameter of fetal head does not reach the level of sciatic spine, and the fetus is exposed above +2.
2. Posterior mental position, anterior position, high straight position or other abnormal fetal position.
3. The fetal distress is serious, and it is estimated that the forceps can't end the delivery immediately.
4. The fetal membrane is not broken and the cervix is not fully open.
5. Fetal malformation. Such as hydrocephalus, anencephaly, Hirschsprung's disease, conjoined fetus, fetal giant teratoma and other serious malformations.
6. stillbirth. The protection of pregnant women should be given priority to when the fetus dies, and abortion is feasible.
10 preoperative preparation 1. Pay attention to monitoring the fetal heart rate and take oxygen when necessary.
2. Disinfect vulva and catheterization.
3.*** Check from outside to inside. First of all, look at whether the vulva is well developed, whether there is inflammation, scar and edema, and how the tissue elasticity is. Then understand the size and texture of the cervix, whether there is edema, and at the same time understand the height and fetal position of the exposed bone. It is also necessary to determine whether the tumor size, skull overlap and pelvic cavity are large enough to judge whether the head and pelvis are commensurate.
4. Check the integrity of fetal membranes, which should be artificially broken.
Oxytocin has been given intravenously. When the uterine contraction is strong, the number of drops should be slowed down to relax the uterus and facilitate the rotation of the fetal head.
6. Prepare medicines and supplies for rescuing neonatal asphyxia.
7.*** Check the height and fetal position of the exposed part, and whether the uterine mouth is fully open.
8. In the case of occipital posterior position or occipital transverse position, the fetal head can be rotated by hand first, so that the sagittal seam of the fetal head is consistent with the anteroposterior diameter of the pelvic outlet before it can be placed. If it is difficult to correct fetal position in occipital posterior position, forceps operation in occipital posterior position is also feasible.
9. After correcting the fetal position, 0.5% ~ 1% oxytocin can be used intravenously to strengthen the uterine contraction.
10. Perineal incision is feasible for primiparas.
1 1. Prepare and inspect tweezers and apply lubricant.
1 1 anesthesia and cystotomy. Unilateral or bilateral nerve block anesthesia.
12 operation steps 12. 1 low forceps operation (1) Place the left forceps: the operator holds the handle of the left forceps with a pen in his left hand, and the concave surface of the forceps spoon faces the fetal head. The right hand extends into the wall from the posterior sacrum, and the fetal head is fixed in the occipital position. The index finger of the right hand buckles the hole in the left ear of the tire, and the middle finger touches the big fontanel at 6 o'clock as a sign of the position of the pillow, so that the left pliers slowly extend into the space between the tire head and the rear wall of the * * * along the palm surface of the right hand (Figure11.2.234.000000056 Put the left pliers spoon on the left ear according to the sign of the left hand. When placing the left clamp, it is best not to put it on the left ear (so that the left ear is placed in the hole of the left clamp), so as not to affect the correct placement of the right clamp.
(2) Place the right-handed pliers: the operator holds the handle of the right-handed pliers with a pen in his right hand, with four fingers of his left hand extending between the fetal head and the right rear wall (Figure 1 1.2.5 16), and slides the right-handed pliers along the left palm to the corresponding position of the left-handed pliers spoon.
(3) Close the forceps lock: If the two forceps are positioned correctly, the forceps lock can be easily locked and the forceps handle can be closed smoothly (Figure 1 1.2.5 18). If the tweezers lock can't be locked, it means that the tweezers are not in the right position. First use the left middle finger to adjust the right pliers key to close the pliers lock. If it is locked, it is still closed.
(4) Check fetal position: the operator puts the index finger of his right hand into * *, and check whether the sagittal seam of fetal head is located on the anteroposterior diameter of pelvic outlet, and whether there is soft birth canal tissue or umbilical cord between forceps spoon and fetal head.
(5) Trial traction: The purpose is to prevent the tweezers from slipping during formal traction. The method is that the index finger, middle finger and ring finger of one hand hold the handle of the pliers and pull it out, and the other hand is fixed on the back of the pliers, and its index finger is close to the fetal head. When trying to pull, if the index finger is always against the fetal head, you can formally pull the forceps, otherwise you should re-check.
(6) Traction forceps: During contraction, gently close the forceps handle, hold the forceps Gaskin in the left hand, with the palm of the right hand pointing downwards, place the middle finger, the index finger and the ring finger on the side protrusions of the forceps lock and the forceps handle respectively, and slowly pull downwards and outwards (Figure 1 1.2.5 19), or the operator can When the occipital tubercle of the fetal head passes under the pubic arch, the forceps handle is gradually lifted upward, so that the fetal head is gradually extended and delivered (Figure11.2.521.1.2.522). If the fetal head cannot be delivered in one contraction, you can slightly loosen the clamp lock, and then gently lock the clamp lock for traction in the next contraction. In an emergency, you can pull the forceps immediately without waiting for contractions.
(7) Dismantling the pliers: When the tire head is pulled out with double top diameter, hold the pliers handle with the right hand and take out the right pliers in the opposite direction of the pliers. When taking out the right forceps, the forceps handle should be taken out obliquely to the left, not parallel to the birth canal to prevent damage. Similarly, remove the left tweezers. If the forceps are removed earlier, it may be difficult to deliver the large-diameter fetal head. When the fetal head is delivered in a large diameter, removing the forceps may increase the perineal soft tissue laceration.
(8) Pulling out the carcass and delivering the placenta: pulling out the carcass according to the natural delivery machine. Assist in the delivery of placenta.
(9) Check the soft birth canal: use a retractor and sponge forceps to expose and check whether the cervix, perineum and perineum are torn, and the lateral incision wound does not extend, and then suture layer by layer.
12.2 the biparietal diameter of fetal head has not reached the level of ischial spine, and sagittal suture is often in the transverse or oblique diameter of pelvis. Therefore, we must first correct the orientation of the fetal head to make it pillow. The procedure of middle forceps operation is basically the same as that of low forceps operation, and its characteristics are as follows:
(1) Placement of forceps: Due to the higher position of fetal head, the position of forceps is also higher. If the fetal position is not correct, after correcting the fetal position, the operator still holds the fetal head with his right hand to keep the correct posture and prevent the fetal head from turning back. Place the left forceps according to the low forceps operation, so that the forceps spoon reaches the left cheek of the fetal head. Then put the tweezers on the right. If it is difficult to close the clamp lock, do not forcibly close it. First adjust the right clamp blade. If it still can't be turned off, please take out the tweezers, check the tire direction, and then reposition.
Due to the high position of fetal head, care should be taken not to clip into the soft tissue or umbilical cord of birth canal during operation. After the pliers are locked, please carefully check the tire direction before attempting traction and traction.
(2) Traction pliers: Due to the high position of fetal head, it is necessary to bend down and pull outward along the birth canal during traction, and the downward angle is slightly larger than that of the low-position pliers. If the sagittal suture is on the oblique diameter of pelvis, gently rotate the tweezers during traction to make the sagittal suture reach the anterior and posterior diameter of pelvic outlet. When the fetal headrest nodule reaches below the pubic arch, it is pulled horizontally upward (Figure 1 1.2.523), so that the fetal forehead, nose, mouth and chin are delivered one after another.
Usually, the fetal head can be delivered after 2 ~ 3 times of traction. In the interval of uterine contraction, the clamp lock should be slightly loose to reduce the pressure on the fetal head.
The operation difficulty of middle tongs is greater than that of low tongs. The higher the fetal head bone, the greater the risk of injury to the soft birth canal and fetus. Therefore, it is rarely used at present, and it is mostly replaced by cesarean section. There is no cesarean section, and it should be done by an experienced doctor.
12.3 Kieran's forceps operation is suitable for rotating traction of fetal head in occipital transverse position, occipital posterior position or uneven inclination of fetal head. There are two ways to place the front pliers: one is sliding method, and the other is traditional method. Let's take the right occipital transverse position as an example to describe it.
(1) sliding method
Orientation of forceps: The operator holds the handle of forceps with his right hand, so that the forehead of forceps and the small button on the handle of forceps face the fetal occipital bone (Figure 1 1.2.523).
Placement of the left front forceps: The operator first holds the forceps spoon of the left front forceps with his right hand (Figure 1 1.2.524), then holds the handles of the left forceps with his left hand one after another, so that the concave surface of the forceps spoon moves forward, and the right hand extends between the * * * rear wall and the right rear side of the fetal head, and then slides the forceps spoon toward the fetal face with his palm (Figure 65438). During the whole operation, the handle of the left pliers is close to the right arm.
Place the right rear forceps: place the right rear forceps according to the operation of the low forceps, and the middle finger of the left hand sequentially pushes the forceps spoon to slide 45 counterclockwise (Figure 1 1.2.527), so that the forceps spoon is placed on the right cheek of the fetal head, opposite to the left forceps spoon.
Fasten the clamp lock: after the two leaf pliers are in place, fasten the clamp lock (Figure 1 1.2.528). Kieran's forceps only have a clamp lock on the left leaf, and the Gaskin point of the right leaf can be engaged with it, so it is less difficult to fasten.
Traction and rotation of fetal head: the operator holds the clamp handle with one hand or both hands, slowly pulls it downward and outward along the axis of the birth canal, and at the same time gently rotates the clamp handle 90 clockwise (Figure 1 1.2.529), so that the sagittal seam of fetal head is transferred to the anterior and posterior diameter of pelvis to continue traction (Figure1.2).
Kieran's forceps are characterized by long spoon, shallow head bend and no basin bend. Therefore, it is suitable for the abnormal position of fetal head in the second stage of labor, and is used to rotate and pull the fetal head to assist fetal delivery. After Kieran's forceps are placed correctly, it can be decided according to the specific situation whether to rotate while traction or separate traction. If the pelvis is wide and the fetus is small, you can rotate while pulling. However, at present, some scholars emphasize that rotation and traction must be separated and cannot be carried out at the same time to prevent mother and child from being injured. Which comes first, rotation or traction, can be determined according to the position of the tire head. The rotation of fetal head should be carried out in the maximum plane of pelvic cavity. If the fetal head is higher than this plane, first pull the fetal head to this plane and then rotate it; If the tire head is lower than this plane, gently push the tire head up to this plane and then rotate it. In general, rotate first and then pull.
(2) Traditional laws
Placement of the left front forceps: Different from the sliding method, the operator puts the middle finger of the right hand into the space between the front wall of the fetal head and the left front side, holds the handle of the left forceps, and the concave surface faces the pubic symphysis. So that the tip of the forceps gently slides into the space between the front wall and the fetal head along the palm surface of his right hand (Figure11.2.30088866). When the operator moves the handle of the forceps down to a horizontal position, the tip of the forceps slides forward into the uterine cavity between the front wall and the finger (Figure1/kloc- And after the concave surface of the forceps spoon faces the uterine cavity, rotate the forceps handle 180, and the concave surface of the forceps spoon turns to the rear to conform to the shape of the fetal head (Figure 1 1.2.533). Then gently pull down the forceps handle (Figure 1 1.2.534) to make the forceps spoon stick to the left parietal temporal part of the fetal head. Steps such as placing tweezers on the right posterior lobe are the same as sliding method.
Kielland believes that when the uterus tightly wraps the fetal head or the tension in the lower part of the uterus is large and thin, the traditional method of placing the left anterior forceps may damage the bladder and uterus, while the sliding method is safer. Therefore, the traditional method of placing pliers is not advocated at present.
12.4 because of persistent posterior occipital delivery obstruction, posterior occipital forceps operation should be performed first. For example, it is difficult to rotate the fetal head, or it is not suitable to rotate the fetal head because of pregnancy complicated with severe pregnancy-induced hypertension syndrome, eclampsia, heart failure and prenatal bleeding. Otherwise, fetal distress must end the delivery quickly. Posterior occipital forceps operation is feasible.
Persistent occipital posterior position is often accompanied by fetal head flexion, fetal head is exposed in an extended state, fetal head is highly exposed, and it is difficult to operate the forceps, which is easy to cause birth canal injury. The procedure of posterior occipital forceps operation is basically the same as that of low forceps operation, which is characterized by: ① large incision. ② Compared with low forceps operation, when placing forceps, the handle of forceps should be slightly lower than the horizontal line, and the longitudinal axis of forceps spoon should be consistent with the mental diameter of fetal head as far as possible (Figure 1 1.2.535). ③ Due to the high position and poor flexibility of the fetal head, when pulling out the forceps, the fetal head should bend slightly downward and gradually turn to the horizontal position. When the fetal head reaches the pelvic floor, it should be pulled slightly upward and outward to help the fetal head bend. When the fetal forehead and nasal root reach below the pubic symphysis, the fetal headrest will be slowly delivered, and then slightly pulled downward and outward, so that the forehead, nose and cheeks will be delivered one after another (Figure 65433
12.5 when using forceps in facial position, the fetal head is extremely extended, which makes the fetal headrest contact with the fetal back. The posterior chin position can't be * * *, and the anterior chin position can be assisted by forceps. The operation steps are basically the same as those of the low forceps, and the characteristics are as follows: ① The incision is large. ② Different from the presentation of fetal head, when placing forceps, the forceps spoon of facial forceps operation is placed on both sides of fetal cheek, and the top of fetal head is within the tip of forceps spoon. The longitudinal axis of the forceps spoon is consistent with the diameter direction of the top chin. When the tweezers are in place and the tweezers lock is closed, the handle of the tweezers should be higher than the horizontal line. (3) Traction forceps: firstly, the mental part of the fetus is pulled downward and outward, and then gradually pulled upward and outward, so that the nose, eyes, forehead and pillow of the fetus are delivered one after another (Figure 1 1.2.537, 165438+).
It is difficult to operate forceps in facial position, which is easy to cause fetal injury and tearing of birth canal, and needs experienced people to carry out it.
After 12.6 posture, the fetal head of Piper's forceps must reach the pelvic floor before operation. The surgical features are as follows: (1) large vaginal incision. ② The assistant lifts or wraps the limbs, trunk and umbilical cord of the fetus, which is easy for the operator to operate. (3) When placing forceps, the operator should press the low forceps and put the forceps into the left lobe from the ventral side of the fetus, so that the forceps spoon can reach the right cheek of the fetal head. Note that the tip of the forceps spoon is slightly upward and the handle of the forceps is slightly downward, so that the longitudinal axis of the forceps spoon is consistent with the mental diameter of the occipital bone. Then, put the right clamp on the left side of the fetal head, opposite to the left clamp spoon. Inside the top of the two pliers is the top of the fetus. ④ Locking pliers and traction pliers. After the clamp is locked, pull outward and upward to bend the tire head. When the occipital bone reaches below the pubic arch, the forceps handle is lifted upward (Figure 1 1.2.539), and the fetal chin, nose and forehead are delivered one after another.
If conditions are limited, Simpson's pliers can also be used instead of Piper's pliers.
Matters needing attention in operation 13 1. Correctly grasp the indications and contraindications of surgery.
2.*** Check carefully, correctly understand the height and biparietal diameter of the lowest part of the fetal skull, as well as the direction of the sagittal seam and the fetal ear, and guide the forceps spoon to be placed on the cheeks on both sides of the fetus.
3. When placing the clamp blade, if the depth cannot be inserted due to resistance, the clamp end may be embedded in the vault of * * * *. At this time, do not forcibly push the pliers edge, and check the reason, otherwise it may cause serious wall damage.
4. After placing the forceps, if the forceps lock is not easy to close, the reasons may be: the fetal position is occipital transverse position, or the forceps position is not correct, so that one forceps spoon is placed on the mastoid part of the fetal head and the other spoon is on the neck; Or one forceps spoon is placed on the forehead of fetal head and the other spoon is placed on the pillow (Figure 1 1.2.540, 1 1.2.5438+0). In this case, if the forceps lock is forcibly closed and pulled, it may cause fetal cerebellar tentorium tear, intracranial hemorrhage, facial paralysis or eyeball injury, severe birth canal tear and even uterine rupture. Therefore, if it is found that the clamp handle cannot be closed, it is necessary to find out the reason and then make appropriate adjustments and treatments.
5. When placing the forceps, if the biparietal diameter has exceeded the uterine orifice and the fetal skull has reached below +2, but there are still small sides of the uterine orifice that cannot be fully opened, the operator's fingertips must be kept in the uterine orifice to prevent damage to the vault.
6. When pulling out the forceps, the force should be even and appropriate, the speed should not be too fast, and the handle of the forceps should not shake left and right.
7. When traction is difficult (that is, the fetal head does not fall), the reasons may be:
① Incorrect traction direction.
② The pelvis does not match the fetal head.
③ The position of fetal head is not suitable, so be careful not to use strong traction, and find out the reasons to correct it, otherwise it will easily lead to fetal and birth canal injuries.
8. Tweezers slip during traction, which may be caused by the following reasons:
① The tweezers are not placed correctly, and the tweezers are shallow or the diameter line is not suitable;
② The fetal head is too big or too small. In any case, the slippage of the forceps will cause serious damage to the fetus and the birth canal, so when fastening the forceps, check whether the blade of the forceps is deep and close to the fetal head. Try traction, stop traction immediately when it is possible to slip, re-check the orientation of fetal head and place forceps.
9. When the fetal head is about to be delivered, the traction speed should be slowed down, and the assistant should cooperate to protect the perineum and prevent the perineum from tearing.
10. If the fetal presentation does not decrease after 2 ~ 3 times of traction, the reason should be checked and cesarean section should be changed in time to avoid losing the opportunity to save the fetus.
14 postoperative treatment after forceps operation, as follows:
1. Because of the long labor process, the fetal head compresses the bladder neck for a long time, and urinary retention may occur. The indwelling catheter should be open for 24 hours after operation.
2. Routine postpartum exploration of the birth canal. If there is a cervical or * * * laceration, it should be sutured immediately.
3. After the newborn was born, intramuscular injection of vitamin k 1/d+0 12mg for 3 days.
4. For those with more operations and longer time, antibiotics can be used to prevent neonatal and maternal infections after operation.
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15 complications 15. 1. 1. Severe scalp edema in newborns can be caused by mild scalp edema after forceps operation and fetal head aspiration, which can be naturally absorbed within 48 hours. Long operation time of forceps, excessive suction negative pressure of fetal head, long traction time, large rotation traction or multiple slippage can all cause severe scalp edema, blisters and abrasions on the top, temporal side and occipital part of fetal head. Newborns should exercise less after birth and be given vitamin K 1 12mg intramuscular injection, 1/d for 3 days. Antibiotic ointment should be applied to abrasions and blisters to prevent infection. Generally, scalp edema is absorbed about 72 hours, and there is no sequela.
15.2 2. The causes of neonatal head hematoma and neonatal scalp edema are the same. There are two types of subdural hematoma and subperiosteal hematoma (figure 1 1.2.542). After the newborn is born, the scalp edema is gradually absorbed, and the hematoma with fluctuating feeling can be touched on the top of the fetus. Subcapsular hematoma is not limited by suture, and the boundary of subperiosteal hematoma is consistent with suture, which has great tension. Bilateral or unilateral parietal hematoma is more common than occipital hematoma. Hematoma of fetal head is absorbed within weeks or 3 months after birth. Large hematoma can be fibrotic or calcified. Hematoma in the head can also aggravate neonatal jaundice, affect appetite and weight gain, and occasionally be complicated with infection. Newborns with head hematoma should be less active after birth and injected with vitamin K 1 12mg intramuscularly for 3 days. If the hematoma is larger than 5cm in diameter, the hematocele can be extracted 24 ~ 48 hours after birth, and fresh whole blood should be added when the hematocele reaches 1% of the child's weight. Massive bleeding under the aponeurosis of the cap. When hemostasis, tooth extraction and dressing are ineffective, the hematoma should be removed by incision. The scalp puncture point is compressed for about half an hour, and gauze is applied for 6 hours.
15.3 3. Intracranial hemorrhage of newborn can be caused by high fetal head position, incorrect fetal orientation, prolonged use of traction forceps or fetal head aspirator or repeated slippage of aspirator. Heavier newborns are more prone to intracranial hemorrhage because of the difficulty of operation, and premature infants are more prone to intracranial hemorrhage because of fragile tissues.
Mild intracranial hemorrhage can be manifested as anxiety, monotonous crying or screaming. Upon inspection, the face is slightly cyanotic and the tension of the front chimney is large, which is a "sunset eye"; Increased limb tension or facial and limb muscle twitching. Severe intracranial hemorrhage, due to the increase of brain pressure, the newborn appears pale, unresponsive, weak breathing, slow heart rate, low muscle tone and even death. Some premature babies only have clinical symptoms about 48 hours after birth, so they should be observed and treated immediately. The treatment of intracranial hemorrhage mainly includes hemostasis, dehydration, sedation, spasmolysis and prevention of infection.
15.4 4. Other neonatal injuries, such as incorrect forceps position and forceps tip pressed against the ear, can cause facial nerve anesthesia, which can recover naturally in about 1 week in mild cases, and require physical therapy in severe cases. When the occipital position is transverse, if the forceps tip is pressed on the orbit, orbital bone fracture and even exophthalmos may occur. If the tip of tweezers is pressed directly on the eyeball, it may destroy the elastic layer behind the cornea, and corneal opacity will appear after birth, leaving visual impairment. Bleeding at the back of the eyeball can also occur, making the eyeball prominent. Immediately press the eyeball with your fingers to stop bleeding for about 10min, and inject a hemostatic agent. If the eyeball is no longer prominent, the bleeding has stopped.
15.5 5. Maternal complications