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PubMed2002

An audit of forceps delivery in Trinidad.

An audit of 247 consecutive forceps deliveries during a 6-year period was undertaken in order to establish trends in recourse to this instrument, maternal complications and fetal outcome. The chief indications were prolonged second stage of labour and poor maternal effort. Our overall forceps rate of 0.81% betrays a marked divergence from the practice in metropolitan countries. Although birth injuries were a major drawback, assistance with forceps still appears to be a safer alternative than caesarean section when a problem exists which impedes spontaneous delivery in the second stage. In choosing between obstetric options, we voluntarily take one course which we dislike because the alternative is more objectionable still; the unpleasantness of the choice does not destroy its reality.

Delivery, Obstetric↗
PubMed2001

Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.

The authors conducted a population-based historical cohort study in the Canadian province of Quebec to assess the maternal and infant outcomes associated with vacuum extraction and forceps deliveries. The study database contains information on 305,391 mother-infant dyads (linked by a common institutional code and hospital chart number) for singleton live vaginal births with a nonbreech presentation at the gestational age of 37 or more completed weeks and a birth weight between 2,500 and 4,000 g during fiscal years 1991/1992 to 1995/1996. Of the births, 31,015 were delivered by vacuum extraction, and 18,727 were delivered by forceps. Compared with delivery by forceps, the adjusted risk ratios for third-/fourth-degree perineal laceration, intracranial hemorrhage, subdural or cerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, cephalhematoma, and neonatal in-hospital death were 0.48 (95% confidence interval: 0.45, 0.50), 1.28 (95% confidence interval: 0.73, 2.25), 0.97 (95% confidence interval: 0.49, 1.93), 0.99 (95% confidence interval: 0.16, 5.97), 5.44 (confidence interval: 1.26, 23.43), 2.02 (95% confidence interval: 1.89, 2.16), and 0.93 (95% confidence interval: 0.32, 2.70), respectively. The authors conclude that vacuum extraction causes less maternal trauma but may increase the risk of cephalhematoma and certain types of intracranial hemorrhage (e.g., subarachnoid hemorrhage).

Adult↗
PubMed1993

Epithelial transformation of the corneal endothelium in forceps birth-injury-associated keratopathy.

Using light and electron microscopy, we studied four keratectomy specimens obtained by penetrating keratoplasty from four patients (ages 33-54 years; mean age: 43 years old) who had clinical evidence of Descemet's folds and bullous keratopathy after ruptures in Descemet's membrane after forceps injury at birth. Histopathologically, three patients showed the typical features of forceps birth injury: Descemet's membrane at the margin of the rupture was folded and assumed a scroll-shape configuration. The fourth patient showed clusters of proliferated endothelial cells at the site of two ruptures, and from one site of the ruptures, these cells invaded into Descemet's membrane, forming a new basement membrane. Transmission electron microscopy revealed that these proliferated cells were epithelial-like cells characterized by desmosomal junctions, basal lamina, numerous microvilli, and 8-nm cytoplasmic filaments. The epithelial transformation of the corneal endothelium was identified in cases of posterior polymorphous dystrophy and assumed to be specific for this entity. The findings in our fourth patient represent the first documentation of epithelial-like cells on the posterior corneal surface in forceps birth-injury-associated keratopathy. Our results suggest that epithelial transformation may be a nonspecific reaction of the young cornea to various stimuli.

Adult↗
PubMed1989

Efficacy of prophylactic antibiotics for the prevention of endomyometritis after forceps delivery.

The purpose of this prospective randomized controlled clinical trial was to determine whether prophylactic antibiotics reduce the incidence of endomyometritis after forceps delivery. Of the 393 patients studied, 192 received 2 gm of intravenous cefotetan after forceps delivery, and 201 patients received no antibiotics. There were seven cases of endomyometritis in the group given no antibiotic and none in the cefotetan group, a statistically significant difference (P less than .01). We conclude that prophylactic antibiotics are effective in reducing the incidence of endomyometritis after forceps delivery. We believe this is the first published study demonstrating this benefit.

Adult↗
PubMed1990

Silastic cup vacuum extractor or forceps: a comparative study.

A retrospective analysis over a 2-year period was carried out to compare the limitations in the use of the Silastic Cup vacuum extractor and forceps as the preferred instrument for operative vaginal delivery. Whilst the use of the vacuum extractor was associated with less maternal morbidity (54.9% episiotomy rate; 20.9% nil analgesia) and comparable neonatal problems, an increased failure rate (6.5%) was demonstrated in comparison to forceps delivery (0.7% failed vaginal delivery rate). A comparison of their use for rotational vaginal delivery failed to reveal any significant difference in maternal or neonatal outcome apart from an increased failure rate (30%) to complete vaginal delivery after application of the vacuum extractor. It is concluded that the vacuum extractor is a comparable instrument for midcavity or lift-out instrumental delivery but Kielland's forceps may still be a more appropriate instrument for rotational vaginal delivery.

Delivery, Obstetric↗
PubMed1984

A continuing use for Kielland's forceps?

A retrospective study over a 5-year period compared neonatal outcomes after birth by Kielland's forceps with those after caesarean section in the second stage of labour. The 253 babies born by these two modes of delivery showed no difference in Apgar score, the need for active resuscitation, incidence of jaundice or abnormal neurological behaviour. The neonatal outcome was no worse in the small number of patients where Kielland's forceps delivery was attempted but failed. This study offers support for the continuing role of Kielland's forceps in modern obstetrical practice.

Adult↗
PubMed1990

The obstetric forceps--are we using the appropriate tools?

A total of 166 pairs of obstetric forceps of three different types in regular use in two major obstetric units was measured and compared with manufacturers' master instruments and drawings. As well as linear measurements of blade, shank and handle the distances between the tips and maximum distance between the blades, and the mean radius of the cephalic curve were determined. The purpose of the study was to assess the suitability of instruments in common use for present day practice. It was found that the measurements differed significantly from the original descriptions and there were wide variations between instruments of the same type, even when supplied by the same manufacturer. In some cases the blades had not been packed in matching pairs in the Central Sterile Supplies Department. It is suggested that critical reappraisal of the forceps in current use in many obstetric units is overdue. As well as a need for reconsidering the type of forceps used the dimensions of individual pairs should be checked.

Equipment Design↗
PubMed1999

Have Kielland forceps reached their 'use by' date?

Kielland forceps have long been used in Australian hospitals for rotation and delivery from occipitolateral and occipitoposterior positions. We have studied the pattern and use of these forceps in our hospital, and conducted a statewide survey of obstetric trainees about their experience with Kielland forceps. We conclude that current obstetric training programmes are unlikely to provide registrars with sufficient skill in their safe use.

Clinical Competence↗
PubMed1999

Neonatal and maternal complications among pregnant women delivered by vacuum extraction or forceps extraction.

A historical cohort study was used to analyse the maternal and neonatal complications among pregnant women delivered by vacuum or forceps extraction at Rajavithi Hospital, 1994. The maternal complications (third and fourth degree of perineal tear and postpartum hemorrhage) were statistically significant more often in the forceps group than in the vacuum extraction group. But fetal complications (neonatal hyperbilirubinemia, low Apgar scores (< 7) at 1 and 5 minutes and the transfer to NICU) were statistically significant more often in the vacuum extraction group than in the forceps group.

Adolescent↗
PubMed1989

[Forceps at a university hospital. Critical study of the evolution of the procedure].

A retrospective study was carried out using the obstetric summaries in a computer between the years 1981 and 1986. The percentage of instrumental deliveries using forceps or spatula was significantly reduced whereas the caesarean section rate stayed the same: the majority of forceps deliveries during the year 1986 (14.5% of all deliveries) were carried out under epidural analgesia (70% of the deliveries) and the mean of these (75%) were carried out for delay. This is a definite change as compared with 1981 and it appears to be linked mainly to an increase in the number of epidural analgesics (70% for forceps deliveries in 1986) and a new appreciation of fetal distress. The maternal results were better because most episiotomies were lateral (60% of cases) which meant that only 1.5% of cases affected the sphincters. The immediate neonatal results were good, but do not seem to have been improved by the changes that have been observed, although the methodology for assessing the state of the neonate has improved.

Extraction, Obstetrical↗
PubMed1988

Barton's forceps deliveries at Paarl Hospital.

Experience in using Barton's forceps for mid-pelvic arrest of the fetal head in 348 cases has proved that this instrument is both easy to apply and safe for the baby, provided rigid adherence to safety criteria are observed. As modern obstetric practice is favourably disposed towards mid-pelvic forceps vaginal delivery, the particular advantages of Barton's forceps should be more widely extolled. Their use is an invaluable addition to the obstetrician's armamentarium. Training in their use should, however, be thorough and extensive and under the guidance of a skilled senior obstetrician.

Extraction, Obstetrical↗
PubMed1984

[Is it legitimate today to perform large rotations with forceps?].

Many authors argue against the practice of large forceps rotations on the basis of a threefold increased neonatal risk compared to the use of forceps for anterior presentations. The experience of the Obstetric Clinic of Hôpital Edouard-Herriot in Lyon, of 81 major forceps rotations from a series of more than 10 000 births, is very similar to that of Chiswick in Manchester, based on 86 cases. In nearly one quarter of the neonates, there are discreet, transient neurological signs which disappear within one week and, did not leave any permanent sequelae. It would appear that large rotations should not be totally forbidden, but that their indications have to be carefully considered, especially in cases of foetal distress. An experienced obstetrician can perform these rotations: in experienced hands, they are often straightforward, but in cases of unexpected difficulty (1 case in 10 or 20) it should be immediately abandoned and a caesarian should be performed.

Apgar Score↗
PubMed1995

[Analysis of the use of the Salinas forceps at the Gynecologic-Obstetric Hospital of Garza García, N.L. (Nuevo León)].

Six hundred and thirteen cases of Salinas forceps application at Hospital de Ginecoobstetricia de Garza García, N.L. from November 1992 to April, 1993, were reviewed. The largest patients group, 20 to 29 years of age with 54.5%; primiparae were predominant with 55.9%, the largest amount of applications in term products, 80.8%; elective forceps with 72.5%; low application with 83.0%; medium 2.5%; episiotomy, medium, right lateral in all the cases; epidural block anesthesia in all the patients, and only one complication 0.1%; most frequent position variety OIA with 50%; and the smaller OIP with 2.6%; 96.3% of products weighted more than 2,500 g; and 87.1% with Apgar 8-9 at one minute. Maternal morbidity, 30.1%; fetal morbidity, 6.1%, with one case with facial paralysis (0.1%) by medium forceps. There were no maternal deaths; 3 antepartum fetal deaths; none postpartum.

Adolescent↗
PubMed1997

Case report: unilateral combined facial nerve and brachial plexus palsies in a neonate following a midlevel forceps delivery.

A case is described in which the 2.7-kg fetus of a nonobese primigravid patient, delivered by midlevel forceps manipulation sustained neurapraxias of both the marginal mandibular branch of the seventh cranial nerve and the upper trunks of the ipsilateral brachial plexus. The pregnancy was uneventful, but labor was complicated by an occipitoposterior presentation and a prolonged second stage. Examination of the neonate revealed bruising and skin markings consistent with injury by obstetric forceps and the anatomic location of these marks suggested that cervical and mandibular compression from the forceps, rather than traction by the accoucheur, would account for the observed findings. A review of the English language literature over the past 30 years revealed only four cases in which a combination of facial nerve and brachial plexus injuries could both be linked to obstetric instrumentation.

Adult↗
PubMed1997

Neonatal intracerebellar hemorrhage after forceps delivery. Report of a case without neurologic damage.

BACKGROUND: Neonatal intracerebellar bleeds are very rare and often seen in association with forceps or vaginal breech deliveries. Frequently the neonate requires surgical evacuation of the hemorrhage. These neonates are most often left with significant neurologic sequelae. Medical management has been reported but with poor outcomes. CASE: A primigravida with a twin gestation delivered at 37 weeks. The delivery was facilitated by the use of low forceps for both infants. Twin B was diagnosed with a massive intracerebellar bleed on day 2 of life. She did not undergo surgical drainage due to an improvement in her clinical status. Follow-up examinations were completely normal, and the infant was developing normally at 2.5 years of age. CONCLUSION: Low forceps deliveries can be associated with massive neonatal cerebellar hemorrhage, and these bleeds can be managed successfully without surgical drainage.

Birth Injuries↗
PubMed1998

[The evaluation of forceps delivery complications].

141 forceps deliveries were studied. The frequency, number and type of complications were evaluated. Decreased number of forceps delivery and relatively high risk of complications in mothers and neonates were indicated. More then half of examined women in childbirth had various injuries of their birth canal. About 30% of new-borns were born with different types of birth's complications. Our results indicate that after forceps delivery the women and new-borns require special care in the perinatal period due to relatively high risk of serious complications.

Female↗
PubMed1998

Tissue thermal damage caused by bipolar forceps can be reduced with a combination of plastic and metal.

BACKGROUND: We created a new 5-mm bipolar forceps. Thermo-insulating plastic was used for the creation of the jaws, while the metal conductor is buried deep inside the plastic. METHODS: A porcine model was used in experimental testing against a standard metallic 5-mm bipolar forceps at three different wattage settings (20, 40, 60 W). Histological sections were evaluated by a pathologist who was blind to the wattage and instrument tested. RESULTS: The new instrument was shown to cause statistically significant reduced thermal damage. In addition, its lateral thermal diffusion is superior to standard bipolar forceps. CONCLUSIONS: Thermo-insulating plastics can reduce thermal damage to tissue during electrosurgery.

Animals↗
PubMed2000

A simple technique of using novel thread-holding and knot-pushing forceps for extracorporeal knot-tying.

We designed some novel knot-pushing forceps for extracorporeal knot-tying and describe herein our simple technique of utilizing them. These forceps are modified only by a single 1-mm hole between their jaws, which hold a thread and push the knot toward the ligating tissue. The application of this simple device was handled well by surgeons beginning to perform advanced endoscopic surgery. The simple modification explained in this report seems applicable to most of the forceps currently used.

Endoscopy↗