[The use of forceps in a university hospital unit]

The authors report a series of 400 forceps deliveries practiced between 1 January 1968 and 30 June 1971, in a university hospital unit. Forceps were used in 3.9 percent of deliveries; 76.9 percent of cases were practiced on primaparas. The authors also note the frequency of narrow pelvis (27.2 percent of cases). The principal indication for the use of forceps is fetal distress or arrested progress (50 percent). Forceps are most often applied at the level of the vulva or in the lower third of the pelvic cavity (44 percent of cases). However, it is also noted that 9 percent of the applications were made in the middle third and that 4.6 percent of the applications were in the upper third (forceps indispensable). Thus the authors challenge the unnecessary use of forceps and note several failures (3.5 percent) that led to Caesarian sections, principally because of feto-pelvic disproportion. Maternal lesions are more frequent when the infant is large, when there is occipito-posterior or occipito-transverse presentation and when the pelvis is slightly narrowed. As regards the fetus, in 400 cases of forceps delivery there was one fetal death connected with the use of the instrument itself. Concerning the problem of persistent posterior presentation, manual rotation should always be attempted, as instrumental rotation is dangerous and should not be used in patients with a narrow pelvis. Rotation of the head towards the front is justified by the reduction in maternal lesions, although the fetal prognosis remains the same. In the face of these statistics, modern obstetrics has evolved and all difficult forceps deliveries have been rejected in favour of Caesarian delivery.