Rotational Forceps: Which technique is superior for blade insertion? A simulation study comparing direct, first...

Area of Science:

• Obstetrics and Gynecology
• Surgical Simulation
• Medical Device Technology

Background:

• Kielland's forceps are crucial for rotational operative births.
• Various blade insertion techniques exist, including direct, first posterior, and wandering maneuvers.
• Optimizing forceps application is key to successful operative vaginal delivery.

Purpose of the Study:

• To compare the effectiveness of three Kielland's forceps blade insertion maneuvers: direct, first posterior, and wandering.
• To evaluate blade placement, reinsertions, and perceived difficulty using a simulator.

Main Methods:

• 144 simulated rotational forceps-assisted births were performed.
• Three maneuvers (direct, first posterior, wandering) were tested by 6 operators (3 experienced, 3 trainees).
• Outcomes assessed included blade asymmetry, distance to posterior fontanelle, reinsertions, and perceived difficulty.

Main Results:

• No significant difference in blade asymmetry among the three maneuvers.
• The direct maneuver resulted in optimal distance from the lock to the posterior fontanelle.
• No differences in reinsertions or perceived difficulty, though experienced obstetricians required fewer reinsertions.

Conclusions:

• The direct maneuver offers advantages for Kielland's forceps blade insertion in rotational operative births.
• Simulation is a valuable tool for comparing obstetric instrument application techniques.