TY - JOUR

T1 - A re-evaluation of the role of rotational forceps

T2 - retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.

AU - Tempest, Nicola

AU - Hart, Anna

AU - Walkinshaw, S.

AU - Hapangama, Dharani

PY - 2013/9

Y1 - 2013/9

N2 - ObjectiveTo compare the outcomes of operative cephalic births by Kielland forceps (KF), rotational ventouse (RV), or primary emergency caesarean section (pEMCS) for malposition in the second stage of labour in modern practise.DesignRetrospective observational study.PopulationData were included from 1291 consecutive full-term, singleton cephalic births between 2 November 2006 and 30 November 2010 with malposition of the fetal head during the second stage of labour leading to an attempt to deliver by KF, RV or pEMCS.MethodsMaternal and neonatal outcomes of all KF births were compared with other methods of operative birth for malposition in the second stage of labour (RV or pEMCS).Main outcome measuresAchieving a vaginal birth was the primary outcome and fetal (admission to special care baby unit, low cord pH, low Apgar, shoulder dystocia, Erb's palsy) and maternal (massive obstetric haemorrhage—blood loss of >1500 ml, sphincter injury, length of stay in hospital) safety outcomes were also recorded.ResultsWomen were more likely to need caesarean section if RV (22.4%) was selected to assist the birth rather than KF (3.7%; adjusted odds ratio 8.20; 95% confidence interval 4.54–14.79). Births by KF had a rate of adverse maternal and neonatal outcomes comparable to those by RV and pEMCS in the second stage for malposition.ConclusionsOur results suggest that, in experienced hands, assisted vaginal birth by KF is likely to be the most effective and safe method to prevent the ever rising rate of caesarean sections when malposition complicates the second stage of labour.

AB - ObjectiveTo compare the outcomes of operative cephalic births by Kielland forceps (KF), rotational ventouse (RV), or primary emergency caesarean section (pEMCS) for malposition in the second stage of labour in modern practise.DesignRetrospective observational study.PopulationData were included from 1291 consecutive full-term, singleton cephalic births between 2 November 2006 and 30 November 2010 with malposition of the fetal head during the second stage of labour leading to an attempt to deliver by KF, RV or pEMCS.MethodsMaternal and neonatal outcomes of all KF births were compared with other methods of operative birth for malposition in the second stage of labour (RV or pEMCS).Main outcome measuresAchieving a vaginal birth was the primary outcome and fetal (admission to special care baby unit, low cord pH, low Apgar, shoulder dystocia, Erb's palsy) and maternal (massive obstetric haemorrhage—blood loss of >1500 ml, sphincter injury, length of stay in hospital) safety outcomes were also recorded.ResultsWomen were more likely to need caesarean section if RV (22.4%) was selected to assist the birth rather than KF (3.7%; adjusted odds ratio 8.20; 95% confidence interval 4.54–14.79). Births by KF had a rate of adverse maternal and neonatal outcomes comparable to those by RV and pEMCS in the second stage for malposition.ConclusionsOur results suggest that, in experienced hands, assisted vaginal birth by KF is likely to be the most effective and safe method to prevent the ever rising rate of caesarean sections when malposition complicates the second stage of labour.

KW - Emergency caesarean section

KW - Kielland forceps

KW - rotational vaginal birth

KW - rotational ventouse

U2 - 10.1111/1471-0528.12199

DO - 10.1111/1471-0528.12199

M3 - Journal article

VL - 120

SP - 1277

EP - 1284

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 10

ER -