[Indications for vaginal delivery with forceps application]

The aim of the study was to establish indications for operative vaginal delivery by extraction of the fetus with forceps in modern obstetrics.

This is a retro- and prospective study which includes 672 forceps deliveries in the period of 1994-2008 in Maternity hospital Sofia. Simpson and Kielland were used for extractions subject to appropriate indications and conditions, regardless of the gestational week of pregnancy.

The most frequent indication for forceps application is fetal asphyxia (78.1%) and considering the frequency for 15 years it is the permanent, leading indication for forceps in modern obstetrics. Arrest of the head in the same plane of the pelvis was the indication in 23.6% of the cases it varies and is rarely primary through the 15 year period. Ineffective uterine contractions and/or pushes (16.7%) tends to decrease its frequency. Avoiding maternal efforts in the second stage of labor (8.5%) and in 50% of the cases was indicated for women with cardiovascular diseases. Malpositions (7.7%) increases through the years probably secondary to epidural analgesia. Indication preeclampsia-eclampsia is described in 1.3% of cases, followed by genital bleeding by 1.9% and prolapse of the umbilical cord by 0.6% and they are more incidentally reasons for application of forceps.

Asphyxia of the fetus is the most common and a leading indication for extraction of the fetus with forceps. Ineffective uterine contractions and the arrest of the head in the same plane of the pelvis are consistent in their occurrence and lead to prolonged labor. In certain critical conditions (genital bleeding, prolapse of the umbilical cord and eclampsia) extraction of the fetus with forceps remains the only way for fast vaginal delivery.