Rotational forceps. Is it safe? 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

The results of the retrospective observational study by Tempest et al. on the outcomes of operative cephalic births using either Kielland forceps or rotational ventouse compared with primary emergency caesarean section for malposition in the second stage of labour do not justify the Abstract. It concludes that in cases of malposition, assisted vaginal birth by Kielland forceps, in experienced hands, is the most effective and safest method in preventing caesarean section. Although this stirs excitement at the possibility of a change in labour ward practice, further analysis reveals that although when compared with rotational ventouse, Kielland forceps reduced the odds of a woman needing a caesarean section (adjusted odds ratio [aOR] 8.20; 95% confidence interval [95% CI] 4.54-14.79), there was no statistical evidence of a reduced risk in maternal morbidity (namely massive obstetric haemorrhage: aOR 0.74; 95% CI 0.09-5.78) or in neonatal morbidity (neonatal admission to special baby care unit: aOR 1.20; 95% CI 0.65-2.22). Therefore the Abstract's conclusion that delivery with Kielland forceps was the safest method in preventing caesarean section cannot be correct.