From the Guidelines
Simpson-Lukehart forceps are primarily indicated for operative vaginal deliveries when there is a need for assistance in the second stage of labor, specifically for deliveries where the fetal head is engaged in the maternal pelvis, typically at station +2 or lower, with complete cervical dilation. These forceps are designed for deliveries where control of the fetal head is necessary, such as in cases of preterm delivery or when delivering the aftercoming head in breech presentations. Common indications include maternal exhaustion, prolonged second stage of labor, fetal distress requiring expedited delivery, or inadequate maternal pushing efforts.
Key Considerations
- The operator must have proper training and experience with forceps deliveries, as improper use can lead to maternal trauma (such as lacerations or pelvic floor injury) or fetal complications (including facial bruising, cephalohematoma, or rarely, intracranial hemorrhage) 1.
- Prerequisites for application include a fully dilated cervix, ruptured membranes, engaged head, empty bladder, adequate anesthesia, and informed consent.
- These forceps should not be used in cases of cephalopelvic disproportion, unengaged fetal head, or incomplete cervical dilation, as this can increase the risk of complications, as noted in the management of impacted fetal head at cesarean delivery 1.
Important Evidence
- The use of a single forceps blade or ventouse, employed abdominally to assist delivery of an impacted fetal head at CD, is not recommended due to the potential for significant fetal injury, such as intracranial and subgaleal hemorrhage 1.
- High-fidelity simulation and implementation of standardized care pathways are likely to represent the safest and most effective form of training for the management of impacted fetal head at CD 1.
- Specifically designed obstetrical spoons, such as the Coyne spoon, Sellheim spoon, and Murless head extractor, have been described to deliver an impacted fetal head, but there is an absence of data demonstrating safety and a risk of inappropriate use resulting in maternal visceral injury 1.
From the Research
Indications for Simpson-Lukehart Forceps
- The indications for Simpson-Lukehart forceps are not explicitly stated in the provided studies, but we can look at the indications for other types of forceps to get an idea of when they might be used.
- Fetal asphyxia is a common indication for forceps delivery, as seen in studies 2 and 3.
- Prolonged second stage of labor is also a common indication for forceps delivery, as seen in study 4.
- Other indications for forceps delivery include:
- It's worth noting that the use of forceps delivery has decreased in recent years, and cesarean section is often preferred in cases where forceps delivery is not possible or safe 4, 3, 5, 6.