Fetal Head Rotation During Instrumented Delivery: What Risks Do We Face? [16N

Abstract

INTRODUCTION: According to the degree of rotation of the cephalic pole, forceps are divided into exit forceps (rotation less than 45°), low (less than 45°) and medium (rotation up to 180°); Our objective was to determine the association between the degree of rotation required during instrumented delivery and the presence of severe perineal tears. METHODS: Retrospective Cohort study, patients in which an instrumental delivery was performed from January 2017 to June 2019 on a single center were included. Patients with incomplete clinical records were excluded. The degree of rotation was evaluated depending on the variety of position prior to placement. Descriptive statistics were performed, χ2 for qualitative variables and Student t for quantitative variables; to determine association, the odds ratio and 95% CI were obtained RESULTS: 131 instrumented deliveries were included; in 100, rotations less than 45° were performed and in 31, rotations equal to or greater than 45° were performed. Severe perineal tears showed no significant difference, however association with lesions of the vaginal wall OR 2.19 (1.31–3.69 95% CI) were observed, with no difference in the amount of bleeding, atony or the presence of obstetric hemorrhage. Of the fetal outcomes, no difference was significant. CONCLUSION: The use of forceps with rotations greater than 45° was not associated with the presence of severe perineal tears only associated with vaginal wall tears, so the decision to perform an instrumented delivery should be conditioned by the development of the work of delivery and not for the degree of rotation that is required.