Forceps operations in perspective. II. Failed operations

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Surgical Outcomes

Background:

• Forceps deliveries are a common obstetric procedure.
• Complications can arise from difficult forceps operations.
• Assessing maternal and fetal risk is crucial for operative delivery outcomes.

Purpose of the Study:

• To review recent cases of failed forceps operations.
• To evaluate the effectiveness of the Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI) in predicting outcomes.
• To establish guidelines for managing difficult forceps deliveries.

Main Methods:

• Retrospective review of 18 failed forceps delivery cases.
• Application of the institution's developed Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI).
• Analysis of maternal and fetal outcomes, including Apgar scores.

Main Results:

• No maternal or fetal deaths occurred in the reviewed cases.
• Over half of high-risk patients had low Apgar scores.
• Low-risk patients generally experienced more favorable outcomes.
• Unsuccessful forceps trials were associated with a 64% chance of unfavorable infant outcome.

Conclusions:

• Cesarean section is recommended when difficulty arises during forceps delivery due to pelvic capacity or fetal size misjudgment.
• High-risk patients should generally not undergo forceps trials.
• Prompt conversion to cesarean section improves maternal and fetal outcomes in complicated forceps deliveries.