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A new breech forceps
A NEW BREECH FORCEPS F. T.
BRENNER,
QUINCY,
T
HIS instrument, which I have been using on a11 cases of breech deIivery for several years, I beIieve is an
M.D.
ILLINOIS
cervix is fully dilated invites a fractured femur or humerus. With the hand we11 Iubricated with heavy green soap (thin
FIG. I. The general shape of the blades is similar to the Elliot pattern. The handIes fit together with a swivel action. The two bIades are detached for application as in the regular forceps. When applied to the baby’s head, the bIades are locked together by a thumb set. When Iocked together they stay set in proper position. Note curve in handIes to fit over the pubis. The spread of blades at the tip is from three inches down.
entirely new type of forceps. After repeated remodeIing it now seems satisfactory. The cut is seIf expIanatory. The idea is to appIy the forceps ozler the child’s body instead of under. AIso the curve of the instrument aIIows the sweep up and over the pubis without hindrance from the baby’s body. The patient shouId be in the Iithotomy position down to the edge of the tabIe. I prefer that both feet be deIivered first and together. This can be done at any stage of delivery, even though the buttocks show at the vulva, provided the patient is To attempt this under fuI1 anesthesia. without fuI1 anesthesia and before the
soap is a mistake) the buttocks can be pushed back up into the we11 reIaxed uterus and the feet easiIy brought down. After both arms are delivered aIIow the baby’s body, face down, to drop down over the edge of the tabIe. At this stage, with the old type forceps, the doctor’s troubIes really begin, trying to adjust the bIades under the body, with onIy a few minutes to go. With this new type, forceps application is no more diffrcuIt than with ordinary cephaIic position. AppIy exactIy the same method. The bIades Iock together with the thumb set. They cannot spring apart. There is no need to hoId them by hand 181
182
American Journnl of Surgery
Brenner-Breech
grip and it is impossibIe to injure the head by hand pressure, because no matter how firmIy you grip the handIes there is positiveIy no pressure on the blades. Grasp the middIe of the curve with one hand and puI1. The other hand pushes the top of the handIes up and over the mother’s abdomen as the head emerges. At the same time the baby’s body is tiIted up over the pubis to foIIow the forceps. Do
Forceps not puI1 on the handles. That would tilt the bIade tips up against the bIadder. As this curve is maneuvered the face foIIows on the same principIe as when we puII with a finger in the baby’s mouth. This tiIting brings the baby’s mouth free at the vuIva. There is no need to hurry now, because the baby can breathe, and there is no need to injure the neck or brachia1 pIexus.
THE appendix of the chiId is Iarger in relation to the size of the abdomina cavity than is that of the ad&, and the mesoappendix is correspondingIy Ionger and less fixed. Therefore, the point of maximal tenderness may vary more in Iocation than it does in the aduIt. It may appear near the midline, we11 down in the peIvis, or even out in the right flank. From-“AbdominaI Surgery of Infancy and Childhood”-by William E. Ladd and Robert E. Gross (W. B. Saunders Company).
BRENNER,
QUINCY,
T
HIS instrument, which I have been using on a11 cases of breech deIivery for several years, I beIieve is an
M.D.
ILLINOIS
cervix is fully dilated invites a fractured femur or humerus. With the hand we11 Iubricated with heavy green soap (thin
FIG. I. The general shape of the blades is similar to the Elliot pattern. The handIes fit together with a swivel action. The two bIades are detached for application as in the regular forceps. When applied to the baby’s head, the bIades are locked together by a thumb set. When Iocked together they stay set in proper position. Note curve in handIes to fit over the pubis. The spread of blades at the tip is from three inches down.
entirely new type of forceps. After repeated remodeIing it now seems satisfactory. The cut is seIf expIanatory. The idea is to appIy the forceps ozler the child’s body instead of under. AIso the curve of the instrument aIIows the sweep up and over the pubis without hindrance from the baby’s body. The patient shouId be in the Iithotomy position down to the edge of the tabIe. I prefer that both feet be deIivered first and together. This can be done at any stage of delivery, even though the buttocks show at the vulva, provided the patient is To attempt this under fuI1 anesthesia. without fuI1 anesthesia and before the
soap is a mistake) the buttocks can be pushed back up into the we11 reIaxed uterus and the feet easiIy brought down. After both arms are delivered aIIow the baby’s body, face down, to drop down over the edge of the tabIe. At this stage, with the old type forceps, the doctor’s troubIes really begin, trying to adjust the bIades under the body, with onIy a few minutes to go. With this new type, forceps application is no more diffrcuIt than with ordinary cephaIic position. AppIy exactIy the same method. The bIades Iock together with the thumb set. They cannot spring apart. There is no need to hoId them by hand 181
182
American Journnl of Surgery
Brenner-Breech
grip and it is impossibIe to injure the head by hand pressure, because no matter how firmIy you grip the handIes there is positiveIy no pressure on the blades. Grasp the middIe of the curve with one hand and puI1. The other hand pushes the top of the handIes up and over the mother’s abdomen as the head emerges. At the same time the baby’s body is tiIted up over the pubis to foIIow the forceps. Do
Forceps not puI1 on the handles. That would tilt the bIade tips up against the bIadder. As this curve is maneuvered the face foIIows on the same principIe as when we puII with a finger in the baby’s mouth. This tiIting brings the baby’s mouth free at the vuIva. There is no need to hurry now, because the baby can breathe, and there is no need to injure the neck or brachia1 pIexus.
THE appendix of the chiId is Iarger in relation to the size of the abdomina cavity than is that of the ad&, and the mesoappendix is correspondingIy Ionger and less fixed. Therefore, the point of maximal tenderness may vary more in Iocation than it does in the aduIt. It may appear near the midline, we11 down in the peIvis, or even out in the right flank. From-“AbdominaI Surgery of Infancy and Childhood”-by William E. Ladd and Robert E. Gross (W. B. Saunders Company).