For delivery of the aftercoming head in breech presentation, a specially designed forceps is used?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019

Explanation

Piper forceps are specifically designed for the unique challenge of delivering the aftercoming head in a breech presentation.
They feature long shanks and a significant perineal curve (a downward arch) that accommodates the baby's delivered body.
This design allows the blades to be applied to the fetal head from below without compressing the baby's trunk or neck, which is crucial for a safe delivery.
The absence of a pelvic curve facilitates direct application to the head, which is still high in the birth canal.

Option A: Das's forceps are general-purpose outlet forceps used for traction when the head is already low in the pelvis. They are not designed for the specific anatomy of an aftercoming head in a breech delivery.
Option C: Kielland's forceps are primarily designed for rotation of the fetal head, for example, to correct an occiput posterior or transverse position. They are not the primary instrument for traction of an aftercoming head.
Option D: Wrigley's forceps are short, light forceps used for low outlet deliveries where the fetal head is visible on the perineum and only minimal traction is needed. They are too short to reach the aftercoming head in a breech presentation, which is much higher in the pelvis.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Indications for different types of obstetric forceps as background academic context rather than a clinical decision trigger.
In any planned vaginal breech delivery, the nursing staff must ensure that Piper forceps are sterile, assembled, and readily available on the instrument trolley as a key piece of equipment.
The procedure requires a skilled assistant (often another nurse or physician) to properly support and elevate the fetal body, allowing the obstetrician clear access to apply the forceps blades.
What if? If Piper forceps are not available or their application is unsuccessful, the provider would resort to manual maneuvers to deliver the head, such as the Mauriceau-Smellie-Veit maneuver, which carries its own set of risks and requires significant skill.

How to Approach the Question

First, identify the key clinical scenario in the question: 'delivery of the aftercoming head in breech presentation'.
Recognize that this is a specific, less common obstetric situation that requires specialized equipment.
Recall the primary indications for different types of obstetric forceps.
Differentiate between forceps used for general traction (Das's), rotation (Kielland's), low outlet deliveries (Wrigley's), and the unique application in breech births.
Select the forceps specifically designed with a perineal curve to accommodate the fetal body, which is the defining feature of Piper forceps.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 28-47