The role of forceps in modern obstetrics

The objective of this study was to assess the safety and devise criteria to minimise complications following forceps deliveries. A prospective analytical study was performed on 644 consecutive forceps deliveries in a Sri Lankan provincial hospital. The incidence of maternal and fetal complications was analysed. The incidence of both cervical and third degree perineal tears was commoner in face-to-pubis deliveries. When the number of traction efforts required to complete the delivery is more than three the incidence of third degree perineal tears and postpartum haemorrhage became significantly commoner. There were six cases of ruptured uterus and all were in multiparous patients following mid-cavity forceps deliveries. The maternal and fetal morbidity following rotational forceps deliveries was no different from non-rotational forceps deliveries. In addition to the standard criteria of head being fully engaged in the pelvis, cervix being fully dilated, the station of the head below the level of the ischeal spines and bladder being empty before attempting forceps delivery, we also recommend that the baby should be delivered occipito-anterior and the number of traction efforts used to be kept at three or less to minimise the maternal trauma.