Kielland's forceps. From controversy to consensus?

Nash, Zachary; Nathan, Bassem; Mascarenhas, Lawrence

doi:10.1111/aogs.12511

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…In the UK, forceps rates have more than doubled in the last 10 years, from 3.3 to 6.8% . In fact, colleagues are advocating the greater use of not just forceps in general, but specifically Kielland's rotational forceps , an instrument that was considered obsolete due to high maternal and neonatal trauma rates, primarily large vaginal tears and neonatal scalp and skull injuries, when I was a student in Heidelberg in 1982–1988. Although there have been such “forward into the past” statements before , these were excusable as long as we were largely unaware of how much damage really occurs to female pelvic floor structures at the time of operative vaginal delivery.…”

Section: Prevalence Of Avulsion Of the Puborectalis Musclementioning

confidence: 99%

“…Hence, it may be difficult to understand why Kielland's forceps seems to be staging a comeback, especially in the UK. This is based on the perception 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”, as stated in this journal recently . The original article that triggered this opinion piece in AOGS was a retrospective study comparing Kielland's rotation with rotational vacuum extraction delivery .…”

Section: Prevalence Of Avulsion Of the Puborectalis Musclementioning

confidence: 99%

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Forceps: towards obsolescence or revival?

Dietz

2015

Acta Obstet Gynecol Scand

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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.

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Section: Prevalence Of Avulsion Of the Puborectalis Musclementioning

confidence: 99%

Section: Prevalence Of Avulsion Of the Puborectalis Musclementioning

confidence: 99%

Forceps: towards obsolescence or revival?

Dietz

2015

Acta Obstet Gynecol Scand

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“…2,9,10 These associations are especially important because forceps deliveries have seen a substantial revival lately. 11,12 After a steady decline in favour of vacuum extraction, there has been a trend reversal in obstetric management and renewed acceptance in national guidelines. 13 Recent studies on forceps delivery claim that peri-natal morbidity is low, [14][15][16][17] but there is also evidence that forceps delivery may be a major risk factor for pelvic floor trauma.…”

Section: Introductionmentioning

confidence: 99%

Delivery mode and pelvic organ prolapse: a retrospective observational study

Trutnovsky

Atan

Martin

et al. 2015

BJOG

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Objective To analyse the associations between delivery mode and symptoms and signs of pelvic organ prolapse (POP) in a cohort of symptomatic women.Design Retrospective observational study.Population A total of 1258 consecutive women attending a tertiary urogynaecological unit for the investigation of lower urinary tract or pelvic floor disorders between January 2012 and December 2014.Methods Obstetric history and clinical examination data were obtained from the unit database. Prolapse quantification on imaging was performed using stored four-dimensional translabial ultrasound volume data sets. Women were grouped into four groups according to the most traumatic delivery reported. The presence of symptoms and signs of POP were compared between delivery groups while controlling for potential confounders.Main outcome measures Prolapse symptoms, visual analogue score for prolapse bother, International Continence Society Prolapse Quantification System findings and ultrasound findings of anterior, central and posterior compartment descent.Results Nulliparae showed the lowest prevalence of most measures of POP, followed by women exclusively delivered by caesarean section. Highest prevalences were consistently found in women delivered at least once by forceps, although the differences between this group and women delivered by normal vaginal delivery and/or vacuum extraction were significant in three out of eight measures only. Compared with women in the caesarean section group, the adjusted odds ratios for reporting symptoms of prolapse were 2.4 (95% CI 1.30-4.59) and 3.2 (95% CI 1.65-6.12) in the normal vaginal delivery/vacuum extraction group and forceps group, respectively.Conclusions There is a clear link between vaginal delivery and symptoms and signs of pelvic organ prolapse in urogynaecological patients.Keywords Caesarean section, delivery, forceps, pelvic organ prolapse.Tweetable abstract Compared with caesarean section a history of vaginal delivery more than doubles the risk for POP.

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“…In the last three decades, there has been a significant reduction in using Kielland's forceps in favour of second stage caesarean section, rotational ventouse, and manual rotation of the fetal head [2]. This decrease could be explained by the lack of training on using Kielland's forceps [3], the poor reputation of Kielland's forceps in the media [4], litigation, and patient expectations [5].…”

Section: Introductionmentioning

confidence: 99%