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Contributing factors in forceps associated pelvic floor trauma
Jessica Caudwell-Hall1, Jennifer Weishaupt2, Hans Peter Dietz3
1Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, 2750, Australia. drjessicacaudwellhall@gmail.com.
International Urogynecology Journal
|January 23, 2019
Summary
Forceps delivery increases fetal head size, raising levator avulsion risk. This study quantises the space added by forceps, finding it partially explains increased trauma during childbirth.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Surgical Instrumentation
Background:
- Levator avulsion affects 10-35% of women post-vaginal delivery.
- Forceps use is a primary risk factor for levator avulsion.
- Proposed mechanisms include increased space, speed, and force during delivery.
Purpose of the Study:
- To quantify the additional space required for fetal head delivery with forceps.
- To assess the contribution of this space requirement to levator avulsion risk.
Main Methods:
- In vitro simulation of forceps application on fetal head models.
- Mathematical modeling of spatial requirements using observational data.
- Measurement of fetal head circumference changes with three forceps types.
Main Results:
- Forceps increased fetal head circumference by 1.01-1.64 cm.
- This translates to a 0.32-0.52 cm increase in head diameter.
- Increased head circumference explained odds ratios of 1.11-1.19 for avulsion.
Conclusions:
- Increased space requirement due to forceps partially explains levator avulsion risk.
- Other factors like delivery speed and applied force likely contribute significantly.
- Further research is needed to fully elucidate forceps-related trauma mechanisms.
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