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Published on: July 7, 2023
Kielland Rotational Forceps Delivery Reduces Ophthalmic Complications Compared to Nagele Non-Rotational Forceps
Shun Masaoka1, Jun Takeda1, Ai Toride2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Objectives:
Non-rotational forceps delivery (NRFD) has a possibility of ophthalmic complications when applied in cases with an oblique sagittal suture. To overcome this and improve the success rate of forceps delivery, we have introduced Kielland rotational forceps delivery (KRFD) since 2016; however, reports about the ophthalmic complications of KRFD are limited. Here, we aimed to investigate the safety and availability of KRFD compared to NRFD.
Methods:
We collected forceps delivery from April 2016 to August 2023, excluding cases using both forceps or ending in cesarean section. Cases were classified as NRFD or KRFD. The rate of ophthalmic complications, such as injuries in the cornea, anterior chamber, sclera, conjunctiva, and retina, was set as a primary outcome.
Results:
We analyzed 1924 NRFD cases and 144 KRFD cases. Complications in the cornea, anterior chamber, or sclera were observed only on the ipsilateral side as the forceps marks on the orbit in NRFD (3.1%). Conjunctival complications were observed only in NRFD but on both sides (ipsilateral 5.1%, contralateral 1.8%). Retinal complications were observed in both NRFD and KRFD but were less frequent in KRFD (NRFD: ipsilateral 9.8%, contralateral 11.2%; KRFD: ipsilateral 0%, contralateral 23.1%). The rate of ophthalmological consultation did not differ significantly between groups.
Conclusions:
KRFD reduced all types of ophthalmic complications compared to NRFD, suggesting that the traction force required during forceps delivery might be reduced when fetal malposition was corrected in KRFD. Proper use of Kielland rotational forceps with good practice would be a more valuable option to achieve safer delivery.
