The Art of Kielland rotational forceps delivery – do we need more training or should we abandon it? That is the question: a retrospective observational study

Abstract

Objective. There has been a wide variation in obstetric practice in the management of women at full cervical dilatation with malposition of foetal head, with many obstetricians preferring delivery by caesarean section over instrumental vaginal delivery. This could be attributed to the scarcity of published data about the safety and feasibility of Kielland's forceps as method of rotational operative vaginal delivery. This was a retrospective study from population-based registry that aimed to assess the potential benefits and harms imposed by Kielland's forceps in comparison to other methods used to assist mid-cavity rotational vaginal delivery, manual rotation and rotational vacuum extraction.Patients and Methods. Seventy-two women, underwent rotational Kielland's forceps vaginal delivery in comparison to Sixty-nine women who had other rotational delivery: 42 rotational ventouse and 27 manual rotations, from October 2015 to October 2019 in the United Kingdom.Results. The results showed 36.2% of the women had maternal complications. However, neither Kielland's forceps nor rotational ventouse exerted any significant effect on developing maternal complications compared to manual rotation (P=0.207 and 0.103 for Kielland's forceps and rotational ventouse respectively) with only one case of perinatal death in Kielland's forceps group. There were no maternal deaths, no thromboembolic events, and no laparotomies or hysterectomies in any of the three groups.Conclusions.Kielland's forceps will remain a safe tool for rotation operative vaginal delivery. However, acknowledging and accepting the associating risks and complications, and obtaining an informed consent from pregnant women is essential before embarking on such procedure.