Forceps operations in perspective. II. Failed operations

Eighteen recent cases of failed forceps operations are reviewed. Although no maternal or fetal deaths occurred, low Apgar scores were found in more than half of those patients considered at significant risk with the use of the Perinatal Morbidity Index (PMI) and Maternal Morbidity Index (MMI) developed at our institution. Among low-risk patients more favorable results were found. Whenever difficulty in a forceps delivery is encountered because of misjudgement of pelvic capacity or fetal size, further attempts at vaginal delivery should cease and a cesarean section should be performed. This procedure will most likely lead to a favorable outcome for mother and child. A patient already at significant risk should, under ordinary circumstances, not be considered a candidate for a forceps trial. If the trial is successful, the infant has a nearly 50% chance of unfavorable outcome; if it is unsuccessful, the chance of an unfavorable outcome is 64%.