Kielland's forceps or ventouse--a comparison

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Neonatal Outcomes

Background:

• Deep transverse arrest of the fetal head is a challenging obstetric complication.
• Instrumental vaginal delivery, using forceps or vacuum extraction, is often employed in such cases.
• Comparing outcomes between Kielland's forceps and ventouse is crucial for clinical decision-making.

Purpose of the Study:

• To compare maternal and neonatal outcomes between Kielland's forceps and ventouse delivery in cases of deep transverse arrest.
• To evaluate the impact of operator experience on maternal morbidity in instrumental deliveries.

Main Methods:

• Retrospective study over a 3-year period.
• Comparison of 117 Kielland's forceps deliveries and 142 ventouse deliveries.
• Analysis of maternal morbidity and neonatal outcomes, including Apgar scores, intubation, special care unit admission, jaundice, neurological behavior, and cephalhaematoma.

Main Results:

• No significant differences in overall maternal morbidity were observed between the two groups.
• Maternal complications were more frequent in the forceps group when performed by less experienced operators.
• Neonatal morbidity was generally low, with no significant differences in Apgar scores, intubation rates, or unit admissions.
• Cephalhaematoma occurred significantly more often in neonates delivered by ventouse compared to Kielland's forceps.

Conclusions:

• Both Kielland's forceps and ventouse are viable options for deep transverse arrest, with comparable overall maternal and neonatal morbidity.
• Operator experience is a significant factor influencing maternal complication rates, particularly with forceps use.
• Ventouse delivery is associated with a higher incidence of neonatal cephalhaematoma.