Outlet forceps in modern era, A Dangerous instrument or an Art of Obstetrics?

Abstract

Abstract : Objective: To assess Feto maternal outcome in outlet forceps delivery. Method: 69 patients in the Labour room who delivered by outlet forceps at Dept. of Obs. and Gyn. Medical college, Baroda, India were analyzed for Feto maternal outcome. Result: Incidence of Wrigley’s outlet forceps delivery is 0.74% in our study. 78.26% were applied for primipara, as may be due to rigid perineum in primipara. 71 % in the age group of 16-25 years, common age of primipara. Age and obstetric outcome it is observed that operative interference is required frequently. Indications of forceps were also comparable with common indications with others. 68.12% baby with normal APGAR scoring. While 2.90% develop Severe Birth Asphyxia and 11.59% required Nursery admission while 15.94% required resuscitation at the time of birth, these shows that with forceps delivery the outcome is comparable to the vaginal delivery. Impression marks over face, abrasion over face are also comparable. Only one neonatal death occurred that was due to Neonatal septicaemia and 4.35% develop cephalhematoma which is slightly higher. The vaginal and cervical tear rates are also comparable. Only Two Patients develop PPH, one (1.45%) traumatic, while other (1.45%) develop Atonic PPH which are comparable to normal vaginal delivery and even after Caesarean section delivery. Only 1.45% patients develop urinary incontinence. Conclusion: - Study performed using Wrigley’s outlet forceps application using ACOG guidelines, 2002/2011. We conclude that maternal and foetal outcome are comparable good with the vaginal delivery. Indicated forceps delivery can reduce the caesarean section rate. No major maternal or foetal morbidity / mortality found due to forceps in study group. We feel that the entire young obstetrician colleague must know the applications of forceps and should implement in practice to decrease the caesarean section rates. Even nowadays Government of India in BEmoc training for Medical Officer (MBBS) in service included the forceps and vaccume delivery in the training course so as to teach them the skill. So that they can help the Nation in lower down the Maternal Mortality Rate. So, we can say that the forceps application with all criteria’s fulfilled in a expert hand is an Art of Obstetrics and not a dangerous Instruments.