Is it Time to Rejuvenate the Forceps?

Abstract

The obstetric forceps was designed to assist extraction of the foetal head and thereby accomplish delivery of the foetus in the second stage of labour. More than 700 types of obstetric forceps have been described. An understanding of the anatomy of the birth canal and the foetal head is a prerequisite to becoming a skilled and safe user of forceps. Operative vaginal delivery rates have remained stable at between 10 and 13 %. The last few decades has seen a rise in caesarean section, along with the introduction and safe use of the vacuum extractor. This has resulted in a decline both in the use of the obstetric forceps as well as in the training for the same. The forceps is less likely to fail when used as the primary instrument thereby reducing the need for the sequential use of two instruments which increase the morbidity of the neonate. Perineal trauma is more likely to occur with the use of the forceps but the evidence is that the maternal concern is less when compared to the ventouse. Simulation training is an important part of obstetric training. Application of forceps blades in the simulation setting can improve the skill level of obstetricians. The use of the forceps should not be decreasing and more senior involvement in training is necessary so that juniors develop the proper skills to perform forceps delivery in a competent and safe manner. It is vital that the art of the forceps is not lost to future generations of obstetricians and the women they care for.

Characteristics and Early Outcomes of Forceps Deliveries in a Tertiary Clinical Center

“…For the past several decades worldwide, the overall instrumental delivery rates seem to be similar and they consistently remain around 18 to 22% of all deliveries (8). Conversely, the use of forceps has declined significantly by year 2000 reaching the lowest level of only 4 % (1 in 25).…”

“…Most studies indicate that perineum trauma such as second and third degree lacerations more likely occur when using forceps than in natural deliveries (8,11). The rate of periurethral injuries and perineum hematomas are also quite frequent in operative vaginal deliveries.…”

“…Therefore, some literature data suggest that after forceps application women are at greater risk of urinary and fecal incontinence, but it seems that no significant complications remain in long-term (≥5 years) (13,14). Moreover, according to some other investigations, less than 10% of women had perineum tears and only 2% had hematomas with no significant damages to the birth canal in case of adequate application of forceps (8,9). Still, there is a general consensus that appropriate training is necessary before carrying out a forceps delivery (8,9).…”

“…Moreover, according to some other investigations, less than 10% of women had perineum tears and only 2% had hematomas with no significant damages to the birth canal in case of adequate application of forceps (8,9). Still, there is a general consensus that appropriate training is necessary before carrying out a forceps delivery (8,9).…”

Childbirth simulation to assess cephalopelvic dystocia and chances for failed labor

“…48 However, instrumental extractions are also associated with greater maternal perineal trauma. 49 Future versions of the PREDIBIRTH software will include recent observations made on the maternal urogenital sinus changes during the second phase of labor with MRI 50 , and it will evaluate the levator ani stretching when the fetal head molding has been intense.…”