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PubMed1997

Failed trial of vacuum or forceps--maternal and fetal outcome.

OBJECTIVE: Our purpose was to compare the maternal and neonatal morbidity associated with a failed trial of instrumental delivery with that of proceeding directly to cesarean section during the second stage of labor. STUDY DESIGN: All second-stage cesarean deliveries between January 1986 and December 1992 in a tertiary care teaching hospital were retrospectively reviewed. Specific maternal and neonatal outcome parameters were studied to compare the failed instrumental group with the direct-to-cesarean section group. RESULTS: Of 29,457 live births at > 37 weeks' gestation, 401 women had a cesarean section performed in the second stage of labor. There were 326 cases in which cesarean section was performed directly during the second stage of labor and 75 women who had a failed attempt of instrumental delivery (forceps 33, vacuum 25, both 17) before cesarean delivery was done. The three instrumental groups and the direct-to-cesarean section group did not differ in any of the outcome variables for either mother or newborn. CONCLUSIONS: Failed instrumental delivery performed as a trial of forceps and/or vacuum in a setting where a cesarean section can follow promptly is not associated with increased morbidity of either mother or baby.

Cesarean Section↗
PubMed2002

Forceps delivery.

This chapter reviews the role for instrumental delivery in current practice and gives a critical account of current techniques of operative vaginal delivery by forceps. Important issues, including case choice, documentation, forceps application, avoidance of complications, and training and education are included.

Extraction, Obstetrical↗
PubMed1988

A device for measurement of radius of curvature of obstetric forceps.

Details of the design of obstetric forceps are important to ensure that they can be used safely for mother and baby. One of the most important measurements is the radius of the cephalic curve of the blades since if this is inappropriate there will be a poor grip on the baby's head and risk of slippage, superficial injury or even intracranial haemorrhage and brain damage because of undue compression. Because of the complex design of the forceps blades, which have a pelvic curve as well as a cephalic curve and a fenestra, the radius of the cephalic curve is difficult to measure. A device was designed to facilitate this measurement and was found to be accurate and reliable in use. This was the first stage in the study to assess the suitability for modern practice of instruments designed many years ago.

Equipment Design↗
PubMed1983

Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps.

In a population of 1065 singleton, low birth weight infants (1000 to 2500 g) delivered vaginally from vertex presentation, the neonatal mortality and morbidity of 394 delivered by low forceps were compared with those of 671 delivered spontaneously. There were no significant differences between the groups, either across the population as a whole or among any of the following birth weight subgroups: 1000 to 1500 g, 1501 to 2000 g, and 2001 to 2500 g. The data in the current study, as well as those from previous reports, argue against the routine use of prophylactic low forceps delivery and in favor of a more individualized approach to the vaginal delivery of infants in vertex presentation in this weight group.

Birth Weight↗
PubMed2005

Obstetric forceps training using visual feedback and the isometric strength testing unit.

OBJECTIVE: This is a descriptive study that tested the maximum traction residents could apply to forceps during simulations. Visual feedback was then used to reinforce an optimal range of traction, and the ability of residents to reproduce this pull when blinded was assessed. METHODS: Fifty-five residents participated in 6 pulling exercises using an isometric strength testing unit with a real-time computer printout of the force applied. Maximum traction was determined for male and female residents in standing and sitting positions. Visual feedback was then used to estimate whether residents could be trained to reproduce an optimal force range of 30-45 pounds. Data were analyzed using a repeated measures analysis of variance. RESULTS: When asked to produce a maximum pull, male residents could generate significantly more force than females in the standing and sitting positions (P < .001). In general, all residents of both sexes generated more traction in the sitting position than in the standing position. The mean maximum traction produced by men in the standing and sitting positions was 69.5 and 85.8 pounds, respectively. For women, the mean maximum force generated was 45.5 pounds in the standing position and 61.3 pounds in the sitting position. Residents could easily reproduce an appropriate force in the short term after training by computer-assisted visual feedback. CONCLUSION: Motor learning tasks using visual feedback can be useful in training practitioners to produce appropriate traction forces during obstetric forceps deliveries. Residents of both sexes, but especially men, can generate traction forces exceeding the recommended limit. Unless tempered by training, forces generated from the sitting position in particular can often exceed the preferred range. LEVEL OF EVIDENCE: II-3.

Adult↗
PubMed1992

Forceps delivery as a risk factor in epilepsy: some further observations.

A total of 381 children born with forceps delivery and 372 with normal delivery were followed up for 4-7 years. More children in the forceps group developed seizures than in the normal group, i.e. 22:10. This was statistically significant (P < 0.05). There was no neurological deficit in any child who had seizures. Both partial and generalized seizures were seen but partial seizures were more frequent.

Child, Preschool↗
PubMed1981

Traumatic intracranial haemorrhage in firstborn infants and delivery with obstetric forceps.

Exclusive of breech presentation, traumatic intracranial haemorrhage was demonstrated at necropsy on 27 occasions in 36 420 consecutive firstborn infants. All 27 were forceps deliveries. The main conclusion is that serious injury to the forecoming head at birth is almost invariably a direct effect of forceps. The relevance of this conclusion to some aspects of contemporary obstetric practice is discussed briefly.

Birth Weight↗
PubMed1983

Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery.

A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear to predispose to an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed to address this still open question more rigorously.

Adult↗
PubMed1984

Should a paediatrician be present at non-rotational forceps deliveries?

In a series of 500 consecutive deliveries there were 35 non-rotational forceps deliveries for delay in the second stage of labour. There was no statistically significant difference in the frequency of resuscitations in this group compared with that in 329 spontaneous vertex deliveries. It is concluded that a paediatrician need not be called routinely to these forceps deliveries when there is no evidence of fetal distress.

Female↗
PubMed1979

Kielland's forceps: role of antenatal factors in prediction of use.

The association between certain antenatal factors and the use of Kielland's forceps was analysed retrospectively in liveborn singleton births that occurred at this hospital between January and December 1976. Factors significantly associated with the use of Kielland's forceps were primiparity, short maternal stature, induction of labour, late engagement of the fetal head, low ratio of maternal height to fetal occipitofrontal head circumference, slow dilatation of the cervix in labour, and the use of epidural analgesia in labour. The findings support a contribution of cephalopelvic disproportion in the genesis of malposition, and when associated with slow dilatation of the cervix delivery should be expedited. Long-term follow-up studies are needed, however, before the role of caesarean section in reducing morbidity associated with malposition can be properly assessed.

Anesthesia, Epidural↗
PubMed1984

Retinal hemorrhages in the preterm neonate. A prospective randomized study comparing the occurrence of hemorrhages after spontaneous versus forceps delivery.

The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29-35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28-35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.

Delivery, Obstetric↗
PubMed1987

Maternal and neonatal morbidity in instrumental deliveries with the Kobayashi vacuum extractor and low forceps.

Risks to the mother and newborn associated with the use of the Kobayashi Silastic vacuum extractor (n = 293) were compared with those associated with the use of low forceps (n = 468) in a retrospective chart review. Third or fourth degree perineal tears and vaginal and cervical lacerations were all observed less frequently among women delivered with the vacuum extractor. The need for post-partum bladder catheterization was also reduced for these women. Babies born by the means of the vacuum extractor ran an increased risk of cephalhematoma and neonatal jaundice. No difference in major neonatal morbidity was observed between the two groups. The Kobayashi instrument appears to be a useful alternative to forceps in low vaginal instrumental deliveries.

Birth Injuries↗
PubMed2000

Effect of epidural analgesia on the primary cesarean section and forceps delivery rates.

OBJECTIVE: To determine the impact of introducing epidural analgesia for labor pain relief on the primary cesarean and forceps delivery rates. STUDY DESIGN: The control group consisted of 1,720 women who delivered on a charity hospital service between September 1, 1992, and August 31, 1993; epidural analgesia was not available for this cohort of patients. The study group consisted of 1,442 patients who delivered on the same service between September 1, 1993, and August 31, 1994; elective epidural analgesia for labor pain relief was available for this cohort of patients. A computerized obstetric database was analyzed to compare the two groups regarding demographics, parity, pregnancy complications, labor characteristics, type of delivery, low birth weight incidence and five-minute Apgar scores. RESULTS: The two groups were similar with respect to demographics and pregnancy complications. No control group patient received epidural analgesia for labor pain relief; 734 of 1,285 (57%) laboring patients in the study group elected epidural analgesia for pain relief. The primary cesarean delivery rate for the control group was 9.6% and for the study group 11.0% (not statistically significant). The control group had 34 (2.0%) forceps deliveries and the study group, 88 (6.1%), for a statistically significant difference. There were significantly more vaginal births after cesarean in the study group (42 vs. 26). CONCLUSION: Epidural analgesia was not associated with an increase in the primary cesarean delivery rate but was associated with an increase in the operative vaginal delivery rate.

Adult↗
PubMed2004

[Giving birth to medical instruments: forceps and pelvimeters among obstetricians of the 19th century in Mexico].

Up until the mid-19th century, Mexican obstetricians associated forceps and other surgical instruments with risky operations, considering them artefacts whose use was to be avoided at all cost. This article asks why by the century's end these same instruments had come to be seen as life-saving surgical utensils. To this end, I analyzed clinical narratives that defined the norms and practices of their use, discovering that although forceps were redefined by male-midwives' norms of prudence, they also introduced medically-based ideas of gender and race and attributed to Mexican women's pelvises a supposedly pathological nature.

Equipment and Supplies↗
PubMed1992

[The inventors of the obstetric forceps and the obstetric lever].

A multiple lineage is proposed for the invention of the obstetric forceps. Having been conceived by a member of the Chamberlen family in fifteenth- or seventeenth-century England, the instrument seems to have been reinvented in Flanders by Jan Palfyn and in Holland by Rogier Roonhuyse. Later, Roonhuyse invented a more effective instrument for coping with the impacted head: the obstetric lever. Palfyn's "Iron Hands" inspired Dussé to produce the "French" forceps which bears his name.

Belgium↗
PubMed1990

[The hazards of forceps: the viewpoint of the pediatrician and the obstetrician].

Neonatal and maternal complications observed after 410 forceps deliveries were retrospectively compared to those occurring after spontaneous vaginal delivery. Mild scalp and facial lesions as well as facial palsy were significantly increased in the forceps group. No severe maternal complications were observed. A short literature review was done, and other instrumental extractions were discussed.

Birth Injuries↗