A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.

摘要

We commend Tempest et al. for providing some of the strongest evidence to date on the management of malposition in the second stage of labour. We are heartened to see that their results strengthen the evidence for the safety of Kielland forceps and the role that they play in reducing the rate of caesarean section in the second stage of labour, alongside the benefit of shorter hospital-isation. We also note the high failure rate of rotational ventouse and feel that this cannot be tolerated given the worse neonatal outcomes associated with sequential instrument use and secondary cesarean section. In summary these results reaffirm our clinical impression that Kielland forceps are the superior tool in the obstetricians' armamentarium. Royal College of Obstetricians and Gynaecologists guidelines state that 'Obstetricians should be confident and competent in... a minimum of one technique for rotational delivery.'2 Operator choice is almost invariably other than Kielland forceps and a change in guidelines will help to make the tool 'mainstream'. Furthermore, our experience shows the situation in the USA to be even more acute with rotational operative vaginal delivery having almost disappeared.