Rotational Forceps Research Articles

A study of patients satisfaction following instrumental deliveries

A study of patient satisfaction following instrumental delivery Introduction Instrumental deliveries are common in the UK with rates between 10 and 13% nationally. Choice of instrument varies but may include ventouse or forceps with rotational instrumental deliveries via manual rotation, rotational ventouse or rotational forceps. However, instrumental deliveries are not without complications, which can confer maternal or neonatal morbidity. Acknowledged complications include vaginal tears, possibly extending to the anal sphincter/mucosa, haemorrhage, infection and is a known risk factor for shoulder dystocia. Fetal complications include subgaleal haematoma, intracranial haemorrhage, facial nerve palsy, cephalhaematoma, neonatal jaundice or retinal haemorrhage. Indications for instrumental delivery may include expedited delivery in fetal compromise, prolonged second stage of labour owing to maternal exhaustion/other reasons or safer delivery in cases where maternal pushing is not advisable. Our unit: We have performed a prospective study between October and December 2015 to investigate patient satisfaction following instrumental deliveries. This was achieved via a proforma with the first part completed by the operating physician and the second part completed by the patient in the first day following delivery. We have, on average, 4000 deliveries in our unit per annum and had 1029 deliveries in the 3-month period. There were 111 instrumental deliveries and we had a return rate of 45% (50). Results: Demographics – in the cohort 35 were primiparous, 15 were multiparous with the majority of women between the ages of 20–30. The fetal head was in the occipito-anterior position in 64% with the remainder either occipito-posterior or occipito-transverse. 46% had forceps delivery, 30% had a ventouse delivery, 18% needed a double instrumental delivery and in only 3 deliveries did the instrumental delivery fail necessitating a second stage caesarean section. The instrumental delivery was performed under a variety of analgesic techniques – 30% local perineal infiltration, 6% pudendal block and 64% regional anaesthesia (epidural or spinal anaesthetic). 30 patients had an episiotomy performed, 7 patients had a third degree tear, 1 patient had a fourth degree tear and 5 patients had major post-partum haemorrhages of >1500 ml. The overall patient satisfaction was high with 94% feeling safe, well informed and that they were treated with respect throughout. 96% were happy they received a good explanation of the procedure including rational, consent and associated risks. 94% felt comfortable throughout with supportive staff. Overall pain scores post procedure was low with only 8% stating they had moderate or severe pain post-natally. 23 of 50 women also added comments with 22 highly positive and only 1 borderline comment, which was regarding explanation by the medical staff as it was an emergency procedure. Conclusion: Overall patient satisfaction in the immediate post-partum period was high despite the aforementioned complication rates.

Kielland's forceps: does it increase the risk of anal sphincter injuries? An observational study.

Rotational instrumental deliveries are thought to carry additional risks compared with non-rotational instrumental deliveries, including trauma to maternal tissues, and require specific expertise and training. We conducted a retrospective study to investigate the association between the type of forceps delivery and maternal perineal trauma, and in particular to investigate if Kielland's rotational forceps delivery increases obstetric anal sphincter injuries (OASIS). This is a retrospective observational study of 1,515 women who attended a tertiary maternity unit over a period of 5 years and had operative vaginal deliveries primarily or completed by forceps. Data were obtained through the hospital's maternity reporting system. The severity of maternal perineal trauma, particularly third and fourth-degree tears in relation to the type of forceps delivery was explored. Multinomial logistic regression models were used to estimate the crude and the adjusted relative risks (RR) of sustaining third-degree tears compared with other types of vaginal tears. Univariate analyses explored the crude associations between relative risks and age, ethnicity, birth weight, type of instrumental delivery and operator's experience. A multivariate multinomial logistic regression model estimated the adjusted relative risks and included all the previous variables as independent covariates. Of the 1,492 women included in the study, 150 women (77 %) had sustained category 1 tears, 63 women (4 %) had sustained category 2 tears and 279 women (19 %) had sustained third-degree tears. There was no statistically significant association between the severity of maternal perineal trauma and the type of forceps delivery (failed ventouse vs Kielland's forceps RR 1.52, p = 0.159 CI 0.84-2.72, Wrigleys vs Kielland's RR 0.59, p = 0.249, CI 0.24-1.43; Andersons vs Kielland's RR 1.16, p = 0.603, CI 0.65-2.05) after adjusting for age, birth weight, BMI, ethnicity and operator experience (full list of covariates not included). The incidence of third- and fourth-degree tears following rotational Kielland's forceps delivery and other non-rotational forceps deliveries is comparable.

Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Kielland Forceps Deliveries.

Fetal malposition is a common indication for Caesarean section in the second stage of labour. Rotational (Kielland) forceps are a valuable tool in select situations for successful vaginal delivery; however, learning opportunities are scarce. Our aim was to identify the verbal and non-verbal components of performing a safe Kielland forceps delivery through filmed demonstrations by expert practitioners on models to develop a task list for training purposes. Labour and delivery nurses at three university-affiliated hospitals identified clinicians whom they considered skilled in Kielland forceps deliveries. These physicians gave consent and were filmed performing Kielland forceps deliveries on a model, describing their assessment and technique and sharing clinical pearls based on their experience. Two clinicians reviewed the videos independently and recorded verbal and non-verbal components of the assessment; thematic analysis was performed and a core task list was developed. The algorithm was circulated to participants to ensure consensus. Eleven clinicians were identified; eight participated. Common themes were prevention of persistent malposition where possible, a thorough assessment to determine suitability for forceps delivery, roles of the multidisciplinary team, description of the Kielland forceps and technical aspects related to their use, the importance of communication with the parents and the team (including consent, debriefing, and documentation), and "red flags" that indicate the need to stop when safety criteria cannot be met. Development of a cognitive task list, derived from years of experience with Kielland forceps deliveries by expert clinicians, provides an inclusive algorithm that may facilitate standardized resident training to enhance education in rotational forceps deliveries.

Forceps: towards obsolescence or revival?

Cesarean section rates have become a political issue, attracting the attention of governments, health bureaucrats and professional organizations. In some instances this has led to a renewed interest in forceps delivery, even Kielland's rotational forceps. It is suggested that calls for a greater use of forceps, especially rotational forceps, are ill-advised and commonly based on ignorance of recent urogynecological and imaging literature. Forceps use is associated with a much higher likelihood of major maternal trauma, especially to the anal sphincter and levator ani muscles, which may result in substantial future morbidity. Hence, its use should be avoided whenever possible. This is particularly obvious for rotational forceps.

Persistent occiput posterior.

Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is improved with bedside ultrasonography. Occiput posterior discovered in the active phase or early second stage of labor usually resolves spontaneously. When it does not, prophylactic manual rotation may decrease persistent OP and its associated complications. When delivery is indicated for arrest of descent in the setting of persistent OP, a pragmatic approach is suggested. Suspected fetal macrosomia, a biparietal diameter above the pelvic inlet or a maternal pelvis with android features should prompt cesarean delivery. Nonrotational operative vaginal delivery is appropriate when the maternal pelvis has a narrow anterior segment but ample room posteriorly, like with anthropoid features. When all other conditions are met and the fetal head arrests in an OP position in a patient with gynecoid pelvic features and ample room anteriorly, options include cesarean delivery, nonrotational operative vaginal delivery, and rotational procedures, either manual or with the use of rotational forceps. Recent literature suggests that maternal and fetal outcomes with rotational forceps are better than those reported in older series. Although not without significant challenges, a role remains for teaching and practicing selected rotational forceps operations in contemporary obstetrics.

Kielland's forceps: demise before the 100th anniversary?

To the Editor: As the time for the centennial of the Kielland’s forceps approaches, one ponders: will this elegant instrument have its demise before its 100th anniversary? Introduced in 1915 by Dr Christian Kielland, a Norwegian obstetrician, for the “deep transverse arrest,” it evolved into the instrument of choice for arrest of descent with occipito-transverse or occipito-posterior position of a cephalic presentation.1.Patterson W.R. The Kielland forceps.Can Med Assoc J. 1928; 18: 177-180PubMed Google Scholar The malpresenting baby would often not be large, as opposed to a non-malpresenting baby that would usually be large to have arrested in the first place. With a high likelihood of failure with attempts at manual rotation or a rotational vacuum, the Kielland’s forceps became an ideal instrument for facilitating a vaginal birth for fetal malposition in cephalic presentation. The relatively straight handle with a gentle backward pelvic curve and a sliding lock were ingenious additions to the obstetric forceps design, allowing easy application to a severely asynclitic head. Further, this design, when combined with the Scanzoni manoeuvre, allowed rotation of up to 180 degrees within the tight constraints of the maternal pelvis due to a relatively small circle of rotation. Given the usual normal-sized baby being delivered, once the head could be successfully rotated, most skilled users would agree that the risk of a significant perineal laceration was small. However, the last decade has witnessed a rapid decline in the use of Kielland’s forceps.2.Ramin S.M. Little B.B. Gilstrap 3rd., L.C. Survey of forceps delivery in North America in 1990.Obstet Gynecol. 1993; 81: 307-311PubMed Google Scholar, 3.Vacca A. Current obstetric training programs are unlikely to provide registrars with sufficient skill in the safe use of Kielland forceps.Aust N Z J Obstet Gynaecol. 2000; 40: 226-227Crossref PubMed Google Scholar This can be attributed to concerns regarding poor neonatal outcomes that were associated with the use of Kielland’s forceps.4.Patel R.R. Murphy D.J. Forceps delivery in modern obstetric practice.BMJ. 2004; 328: 1302-1305Crossref PubMed Scopus (95) Google Scholar In the litigious field of obstetrics, it was tempting to give up a controversial practice for the easier option, the Caesarean section. Given the medico-legal climate, although North American centres were slow in adopting the use of Kielland’s forceps, they were quicker to let it go. However, more recent evidence suggests that the concerns regarding neonatal outcomes may have been misplaced. A retrospective review of deliveries at a tertiary care centre over a four-year period compared the use of Kielland’s forceps, rotational ventouse and emergency Caesarean section.5.Tempest N. Hart A. Walkinshaw S. Hapangama D.K. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.BJOG. 2013; 120: 1277-1284Crossref PubMed Scopus (72) Google Scholar With a 25% Caesarean section rate and a 13% operative vaginal delivery rate, a cohort of approximately 1300 cases that reached full cervical dilatation with fetal malposition was identified. With an intention-to-treat analysis, 80% had an attempted Kielland’s rotation, 8% had an attempted rotational ventouse, and 11% had an emergency Caesarean section. The likelihood of needing a Caesarean section was eight-fold higher if a ventouse was used as opposed to the Kielland’s forceps. Failure of delivery with Kielland’s occurred in 4% of cases. Other than a trend towards an increased rate of shoulder dystocia, no increase in adverse outcomes was noted.5.Tempest N. Hart A. Walkinshaw S. Hapangama D.K. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.BJOG. 2013; 120: 1277-1284Crossref PubMed Scopus (72) Google Scholar However, obstetric practice changed before the evidence relating to the long-term outcomes of babies could become available,6.Kotaska A. Menticoglou S. Gagnon R; SOGC Maternal Fetal Medicine Committee. Vaginal delivery of breech presentation. SOGC Clinical Practice Guideline no. 226, June 2009.J Obstet Gynaecol Can. 2009; 31 (567–78): 557-566Abstract Full Text PDF PubMed Scopus (72) Google Scholar leaving a generation of obstetricians who are untrained in the science and art of a rotational forceps delivery. With increasing Caesarean section rates and associated maternal morbidity and mortality, we need ongoing efforts to find viable alternatives to Caesarean section. This leads to the question: is it time to revive the Kielland’s forceps delivery before it is too late? Or should we helplessly watch this endangered species disappear and become a part of the annals of the history of medicine?

A Reevaluation of the Role of Rotational Forceps

A Reevaluation of the Role of Rotational Forceps

The Rise and Decline of Operative Obstetrics or, the Joys of a Peripatetic Obstetrician

I awoke and it was a dream. This has encouraged me to share with you the joys of a peripatetic obstetrician who spent more than 40 years practising obstetrics when obstetrics, particularly operative obstetrics, truly was an Art. Sadly this is no longer the case, although one could, if one had the necessary experience, still practise this kind of obstetrics in a developing country where the patient would bless you for having saved her child and for having preserved her from a feared Caesarean section. It is almost impossible to convey the sense of achievement, joy and wonder when, bathed in sweat, after a difficult rotational forceps or breach delivery, one stands gazing at a new creation and shares with the parents their varying emotions.

Kielland's forceps. From controversy to consensus?

Kielland's rotational forceps are designed to overcome malposition of the fetal head in the second stage of labor. After a decline in their use because of reported adverse outcomes and fear of litigation, recent evidence suggests that they may be safe and effective in trained hands and significantly more successful at achieving operative vaginal delivery than either rotational ventouse or manual rotation. This is important because of the increased short and long-term morbidity related to cesarean section compared with the reduced morbidity of subsequent pregnancy after operative vaginal delivery. Kielland's forceps are therefore re-emerging as a useful instrument in the armamentarium of modern obstetrics. Limitations to wider use of Kielland's forceps are the lack of training opportunities as well as that contemporary evidence remains underpowered to detect rare adverse outcomes.

Management of fetal malposition in the second stage of labor: a propensity score analysis

We sought to determine the factors associated with selection of rotational instrumental vs cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments vs cesarean delivery. We conducted a retrospective cohort study over a 5-year period in a tertiary United Kingdom obstetrics center. In all, 868 women with vertex-presenting, single, liveborn infants at term with persistent malposition in the second stage of labor were included. Propensity score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean delivery. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse vs cesarean delivery, adjusting for propensity scores. Increased likelihood of rotational instrumental delivery was associated with lower maternal age (odds ratio [OR], 0.95; P < .01), lower body mass index (OR, 0.94; P < .001), lower birthweight (OR, 0.95; P < .01), no evidence of fetal compromise at the time of delivery (OR, 0.31; P < .001), delivery during the daytime (OR, 1.45; P < .05), and delivery by a more experienced obstetrician (OR, 7.21; P < .001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8 ± 48 mL, P < .001). Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean delivery rates.

Erratum

BJOG: An International Journal of Obstetrics & GynaecologyVolume 121, Issue 10 p. 1322-1322 ErratumFree Access Erratum This article corrects the following: Authors' reply: A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour N Tempest, A Hart, S Walkinshaw, D Hapangama, Volume 121Issue 5BJOG: An International Journal of Obstetrics & Gynaecology pages: 644-646 First Published online: March 18, 2014 First published: 25 August 2014 https://doi.org/10.1111/1471-0528.12910AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the following letter1 there were errors made in the following sentences: The sentence read: Simulated training may have a place in introducing the trainees to Kielland forceps and other rotational delivery methods2 but we do not believe that it has the ability to replace the clinical training/assessment of operators of rotational deliveries. It should have read: Simulated training may have a place in introducing the trainees to Kielland forceps and other rotational delivery methods3 but we do not believe that it has the ability to replace the clinical training/assessment of operators of rotational deliveries. The sentence read: We disagree with Gale et al.3 regarding their comment on a discrepancy between our results and the abstract. It should have read: We disagree with Ekechi4 regarding their comment on a discrepancy between our results and the abstract. The sentence read: The second point raised by Gale et al.3 on lack of data on station, presence of caput/moulding and contractions has already been mentioned in our discussion. It should have read: The second point raised by Ekechi4 on lack of data on station, presence of caput/moulding and contractions has already been mentioned in our discussion. We apologise for this error. ■ References 1Tempest N, Hart A, Walkinshaw S, Hapangama D. Authors’ reply. BJOG 2014; 121: 644– 6. 2Nash Z, Mascarenhas L, Nathan B. A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour. BJOG 2014; 121: 642– 3. 3Gale A, Siassakos D, Attilakos G, Winter C, Draycott T. Operative vaginal birth: better training for better outcomes. BJOG 2014; 121: 643– 4. 4Ekechi CI. Rotational forceps. Is it safe? A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour. BJOG 2014; 121: 644. Volume121, Issue10September 2014Pages 1322-1322 ReferencesRelatedInformation

PFM.32 Third trimester amniocentesis for the diagnosis of haemophilia A and B

Haemophilia A and B are bleeding disorders inherited in an X linked recessive manner. Female carriers of these conditions have a 50% chance of delivering an affected infant when pregnant...

Rotational forceps. Is it safe? A re‐evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour

Rotational forceps. Is it safe? A re‐evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour

Reintroducing Kielland forceps

It is always reassuring to find that the conclusions made in a contemporary article in a biomedical journal mirror the conclusions and decision made in a judicial review. Tempest et al. recently reported on over 1200 forceps, ventouse, or manual rotations performed in mothers with arrest of descent, with the fetal head not in an occiput anterior position (BJOG 2013;120:1277–84). They conclude that ‘assisted vaginal birth by Keilland forceps is likely to be the safest and most effective’ mode of delivery. In 2007 the Scottish Court of Sessions ruled in a case in which a transverse arrest of descent was treated with a trial of rotational forceps that failed (Dinley versus Lothian Health Board). The birth was completed abdominally and the baby went on to develop encephalopathy, and ultimately, cerebral palsy. The plaintiff alleged negligence both in the decision to try a forceps rotation and the conduct of the operation itself. Lord Hodge weighed the evidence and expert opinions, and concluded that even though some experts consider that a trial of forceps was not appropriate, a substantial volume of medical literature supports this approach as safe and effective. Moreover, the excellent documentation by the operating clinician established that the requirements for such a rotational delivery to be appropriate had been met, and the procedure was performed properly. The doctor and health facility were found not guilty of negligence. Both the justice system and Tempest et al. have identified the prerequisites for a forceps rotation to be justifiable. These include: an experienced operator, adequate anaesthesia, certainty of fetal position and station, and access to acute emergency abdominal delivery and neonatal resuscitation. In my hospital, these can only be achieved by moving the mother to an operating room, having anaesthesia and paediatric teams present, and being prepared to abandon the attempt at forceps delivery if it proves to be too difficult. We duplicate the old ‘double set–up’ approach used in the days before the antepartum diagnosis of placenta praevia could be made easily, so we are under no pressure to complete the delivery with forceps. So, given this alignment of solicitors and surgeons, why are fewer and fewer forceps operations attempted in contemporary practice? MJ Dickson, in his letter regarding the Tempest paper (BJOG 2013;120:1438), highlighted the problems. As a surgical procedure is attempted less and less, collective experience wanes, as does confidence and competence. With fewer competent and confident practitioners as models, learners are not exposed to success and thus ‘lack the training’ to attempt the procedure. Before this valuable tool in the work box of the accoucheur is relegated to the ‘dustbin of history’ we must actively bring it back into practice. This is a moment amidst free fetal DNA and epigenetics for senior obstetricians to shine. Those of us with competence and confidence need to take advantage of the teaching experiences beckoning in labour and delivery. Ian Treharne presents the intriguing idea of a ‘Keilland forceps club’ (letter in this issue), with an experienced mentor to enhance clinical training. Perhaps every institution needs one? None declared. Deputy Editor-in-Chief profile available at www.BJOG.org

The role of rotational forceps

BJOG: An International Journal of Obstetrics & GynaecologyVolume 121, Issue 5 p. 641-642 BJOG Exchange The role of rotational forceps C Hardy, C Hardy Belfast South-Eastern Health & Social Care Trust, Ulster Hospital, Dundonald, Northern IrelandSearch for more papers by this authorR Roberts, R Roberts Belfast South-Eastern Health & Social Care Trust, Ulster Hospital, Dundonald, Northern IrelandSearch for more papers by this author C Hardy, C Hardy Belfast South-Eastern Health & Social Care Trust, Ulster Hospital, Dundonald, Northern IrelandSearch for more papers by this authorR Roberts, R Roberts Belfast South-Eastern Health & Social Care Trust, Ulster Hospital, Dundonald, Northern IrelandSearch for more papers by this author First published: 18 March 2014 https://doi.org/10.1111/1471-0528.12603Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume121, Issue5April 2014Pages 641-642 RelatedInformation

Rotational forceps training needs to be scaled up

Rotational forceps training needs to be scaled up

A re‐evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour

BJOG: An International Journal of Obstetrics & GynaecologyVolume 121, Issue 5 p. 642-643 BJOG Exchange A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour Z Nash, Z Nash King's College, London, UKSearch for more papers by this authorL Mascarenhas, L Mascarenhas St Thomas's Hospital, London, UKSearch for more papers by this authorB Nathan, B Nathan Riverside Hospital, London, UKSearch for more papers by this author Z Nash, Z Nash King's College, London, UKSearch for more papers by this authorL Mascarenhas, L Mascarenhas St Thomas's Hospital, London, UKSearch for more papers by this authorB Nathan, B Nathan Riverside Hospital, London, UKSearch for more papers by this author First published: 18 March 2014 https://doi.org/10.1111/1471-0528.12559Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume121, Issue5April 2014Pages 642-643 RelatedInformation

Authors' response to: The role of rotational forceps

Authors' response to: The role of rotational forceps

The role of rotational forceps

BJOG: An International Journal of Obstetrics & GynaecologyVolume 120, Issue 11 p. 1438-1438 BJOG Exchange The role of rotational forceps MJ Dickson, MJ Dickson Cheshire, UKSearch for more papers by this author MJ Dickson, MJ Dickson Cheshire, UKSearch for more papers by this author First published: 11 September 2013 https://doi.org/10.1111/1471-0528.12386Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume120, Issue11October 2013Pages 1438-1438 RelatedInformation

Maternal and Neonatal Outcomes of Successful Kiellandʼs Rotational Forceps Delivery

OBJECTIVE To estimate the rates of early neonatal and maternal complications in a consecutive series of successful Kielland's rotational forceps deliveries. METHODS This was a retrospective cohort study of consecutive cases of successful rotational forceps deliveries performed in singleton pregnancies at 36 weeks of gestation or more in a tertiary referral center in Scotland, UK, from 2001 to 2008 (n=873). We also compared outcomes associated with successful rotational forceps deliveries in 2008 (n=150) with those of nonrotational forceps delivery (n=873), ventouse delivery (n=159), spontaneous vertex delivery (n=3,494), and emergency cesarean delivery (n=947). RESULTS There was one stillbirth associated with a rotational forceps delivery. This was diagnosed before application of forceps. After rotational forceps deliveries, 58 of 872 (6.7%) of live-born neonates were admitted to the neonatal unit. Twenty-seven of 872 (3.1%) neonates had one or more complications that could be attributable to traumatic delivery and seven neonates (0.8%) had a diagnosis of neonatal encephalopathy. When compared with alternative methods of delivery over a single year, neonatal admission rates after delivery by rotational forceps deliveries (5 of 150 [3.3%]) were not significantly different from spontaneous vertex delivery (128 of 3,494 [3.7%; P=1.00]) or ventouse delivery (6 of 159 [3.8%; P=1.00]) and lower than emergency cesarean delivery (106 of 947 [11.2%; P=.002). Postpartum hemorrhage rates after rotational forceps deliveries (8 of 150 [5.3%; P=.008]) were lower than those associated with emergency cesarean delivery (142 of 947 [15.0%; P=.008]). CONCLUSION Rates of short-term neonatal and maternal complications after successful rotational forceps deliveries are low. LEVEL OF EVIDENCE II.