A randomised prospective trial of the obstetric forceps versus vacuum extraction using defined criteria

The objective of this study was to determine the safety of obstetrics forceps when used under strictly defined criteria compared to vacuum extraction for delivery in the second stage of labour. A randomised prospective trial was performed on 442 women undergoing instrumental delivery in the second stage. Two hundred and four women were in the forceps group and 238 in the vacuum group. When using forceps traction efforts to deliver the baby were kept to less than three and the head was always delivered in the occipito-anterior position. In the two groups there were no significant difference in the incidence of third-degree perineal tears, post-partum haemorrhage or ruptured uterus. Cervical tears were slightly higher in the forceps group. Babies delivered by vacuum extraction showed a higher incidence of cephalhaematomas. There was no significant difference in babies needing resuscitation at birth, admission to neonatal intensive care unit, stillbirth or neonatal death rates. The failure rate was significantly higher in the vacuum group. The time taken to complete the procedure was significantly less in the forceps group. Forceps deliveries when performed under defined criteria are as safe as vacuum deliveries to the mother with a lesser failure rate and a lower incidence of cephalhaematomas in the neonate compared with vacuum deliveries.