Fig. 108.—Patient in position and draped for forceps operation. (From photograph taken at Johns Hopkins Hospital.)
Otherwise, there is danger of necrosis or sloughing of the soft parts as a result of pressure, with a subsequent recto-vaginal or vesico-vaginal fistula.
Among the acute conditions in which forceps are indicated are typhoid fever; pneumonia; acute edema of the lungs, hemorrhage from premature separation of the placenta; intra-partum infection and eclampsia, while they are sometimes used in such chronic conditions as pulmonary tuberculosis; various heart lesions, particularly when there is broken compensation.
Before applying forceps the operator will usually wish to satisfy himself that the following conditions exist: Complete dilatation of the cervix, otherwise severe lacerations with hemorrhage may result; the head must have entered the pelvis, otherwise an imperfect application of the forceps may result in death of the fetus and serious injury to the mother; the position of the child’s head must be known in order that the forceps may be properly applied over the ears; the membranes must have ruptured or the forceps may slip.
Forceps operations are usually designated as being high, mid or low, depending upon the level to which the head has descended into the pelvis. If the head is at the superior strait, a high forceps operation is necessary; mid forceps if the head is half way down and on a level with the ischial spines and low forceps when the head is on or just above the perineum.
Fig. 109.—Forceps sheet used in Fig. [108].
The application of low forceps is a simple operation and attended by little danger to mother or child; mid forceps is more serious and high forceps is very serious for the child and sometimes for the mother.
When forceps are applied, the patient must be at the edge of the bed or preferably on a table, in the lithotomy position (Fig. [108]), and completely anesthetized. She should be shaved and scrubbed as for a normal delivery, after which a sterile towel soaked in bichlorid 1–1,000 or lysol 2 per cent., is placed over the vulva and allowed to remain until the operation is performed. She should be draped with sterile leggings and towels, one of which is folded over the centre of a wide strip of adhesive about twenty inches long, and hung curtain-like over the rectum by strapping the free ends to the buttocks on each side, while over all is placed a sheet with three openings; two slits for the legs to pass through and one rectangle which exposes the field of operation. (Figs. [109], [110].)