Related Experiment Video
Updated: Nov 5, 2025
Quantification of Levator Ani Hiatus Enlargement by Magnetic Resonance Imaging in Males and Females with Pelvic Organ Prolapse
Published on: April 17, 2019
Rotational forceps: a retrospective study evaluating anatomical and functional consequences for the pelvic floor.
Ismael Ortega1, Hans Peter Dietz2, José Ángel García-Hernández3
1Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario Insular-Materno Infantil, Avenida Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Spain. iortcar@gobiernodecanarias.org.
Rotational forceps use is linked to a significantly higher rate of levator muscle avulsion compared to non-rotational forceps. This finding highlights the need for careful consideration of potential long-term maternal pelvic floor trauma.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Surgical Interventions
Background:
- Kielland's rotational forceps are associated with technical challenges and potential pelvic floor trauma.
- Levator muscle avulsion is a significant complication following instrumental vaginal delivery.
Purpose of the Study:
- To evaluate the association between levator muscle avulsion and the use of rotational versus non-rotational forceps.
- To assess the impact of rotational forceps on pelvic floor integrity.
Main Methods:
- Observational study of 165 primiparous women undergoing Kielland's forceps delivery.
- Urogynecological interview, clinical examination, and 4D translabial ultrasound (TLUS) were performed.
- Blinded analysis of TLUS data by an experienced examiner.
Main Results:
- Rotational forceps were used in 27.3% of cases.
- Levator avulsion occurred in 41.8% of all forceps deliveries.
- Rotational forceps were significantly associated with levator avulsion (adjusted OR 2.57).
Conclusions:
- Rotational forceps are associated with a more than 2.5-fold increased risk of levator muscle avulsion.
- Obstetricians should weigh the risks of rotational forceps against potential long-term maternal consequences.
