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KIELLAND'S FORCEPS: PAST, PRESENT AND FUTURE

Published online by Cambridge University Press:  27 April 2012

MARTIN CAMERON*
Affiliation:
Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
*
Martin Cameron, Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR7 4UY, United Kingdom Email: martin.cameron@nnuh.nhs.uk

Extract

Kielland's forceps have been in obstetric practice for over 80 years but their use causes a wide spectrum of reactions in obstetricians. Those that have been well tutored in their use argue that they are a very effective instrument to achieve vaginal delivery in the malpositioned fetus, avoiding the problems of full cervical dilation caesarean section, with low complications in their hands. These exponents of the instrument argue that the “art” of obstetrics is demonstrated in the use of Kielland's forceps. However, others claim that Kielland's forceps are dangerous with high complication rates and that they should be confined to the obstetric museum. This paper reviews the history of the instrument and its inventor, to consider evidence for its effectiveness and its safety, to briefly consider other methods for delivery of the malpositioned fetus at full cervical dilation and finally to complete the journey by considering the future with particular emphasis on training the new generation of obstetricians.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1Kielland, C.The application of forceps to the unrotated head. A description of a new type of forceps and a new method of insertion (translated title). Geburtshilfe und Gynakologie 1916; 43: 4878.Google Scholar
2Dunn, PM. Dr Christian Kielland of Oslo (1871–1941) and his straight forceps. Arch Dis Child Fetal Neonatal Ed 2004; 89: F46567.CrossRefGoogle ScholarPubMed
3Bahl, R, Strachan, B, Murphy, DJ. Operative vaginal delivery. RCOG Greentop Guidelines 2011; 26.Google Scholar
4Akmal, S, Tsoi, E, Kametas, N, Howard, R, Nicolaides, KH. Intrapartum sonography to determine fetal head position. J Matern Fetal Neonatal Med 2002; 12: 172–77.CrossRefGoogle ScholarPubMed
5Johanson, R, Menon, V. WITHDRAWN: Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev CD000224, 2010.CrossRefGoogle Scholar
6Josephs, KS, Denison, FC, Akolekar, R, Cooper, ES, Stock, SJ. Maternal and neonatal outcomes following Kielland's rotational forceps delivery. Arch Dis Child Fetal Neonatal Ed 2010; 95: Fa9.CrossRefGoogle Scholar
7Weerasekera, DS, Premaratne, S. A randomised prospective trial of the obstetric forceps versus vacuum extraction using defined criteria. J Obstet Gynaecol 2002; 22: 344–45.Google ScholarPubMed
8Bofill, JA, Rust, OA, Schorr, SJ, Brown, RC, Martin, RW, Martin, JN Jr, et al. A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Am J Obstet Gynecol 1996; 175: 1325–330.CrossRefGoogle ScholarPubMed
9Johanson, RB, Rice, C, Doyle, M, Arthur, J, Anyanwu, L, Ibrahim, J et al. A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. Br J Obstet Gynaecol 1993; 100: 524–30.CrossRefGoogle ScholarPubMed
10Williams, MC, Knuppel, RA, O'Brien, WF, Weiss, A, Kanarek, KS. A randomized comparison of assisted vaginal delivery by obstetric forceps and polyethylene vacuum cup. Obstet Gynecol 1991; 78: 789–94.Google ScholarPubMed
11Johanson, R, Pusey, J, Livera, N. Jones P. North Staffordshire/Wigan assisted delivery trial. Br J Obstet Gynaecol 1989; 96: 537–44.CrossRefGoogle ScholarPubMed
12Fall, O, Ryden, G, Finnstrom, K, Finnstrom, O, Leijon, I. Forceps or vacuum extraction? A comparison of effects on the newborn infant. Acta Obstet Gynecol Scand 1986; 65: 7580.CrossRefGoogle ScholarPubMed
13Dell, DL, Sightler, SE, Plauche, WC. Soft cup vacuum extraction: a comparison of outlet delivery. Obstet Gynecol 1985; 66: 624–28.Google ScholarPubMed
14Vacca, A, Grant, A, Wyatt, G, Chalmers, I. Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery. Br J Obstet Gynaecol 1983; 90: 1107–112.CrossRefGoogle Scholar
15Maleckiene, L, Railaite, DR. A randomized comparison of assisted vaginal delivery by vacuum extractor and obstetrics forceps. Prenat Neonat Med 1996; 318: 1 Suppl 1.Google Scholar
16Lasbrey, AH, Orchard, CD, Crichton, D. A study of the relative merits and scope for vacuum extraction as opposed to forceps delivery. S Afr J Obstet Gynaecol 1964; 2: 13.Google Scholar
17Salamalekis, E, Loghis, C, Zourlas, PA. Soft cup vaccum extractor versus forceps delivery. J Obstet Gynaecol 1995; 15: 245–46.CrossRefGoogle Scholar
18O'Mahony, F, Hofmeyr, GJ, Menon, V. Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev CD005455 2010.CrossRefGoogle Scholar
19Fitzpatrick, M, Behan, M, O'Connell, PR, O'Herlihy, C. Randomised clinical trial to assess anal sphincter function following forceps or vacuum assisted vaginal delivery. BJOG 2003; 110: 424–29.CrossRefGoogle ScholarPubMed
20Mustafa, R, Mustafa, R. Perinatal and maternal outcome in ventouse versus forceps delivery. J Coll Physicians Surg Pak 2002; 12: 345–47.Google Scholar
21Chiswick, ML, James, DK. Kielland's forceps: association with neonatal morbidity and mortality. Br Med J 1979; 1: 79.Google Scholar
22Healy, DL, Quinn, MA, Pepperell, RJ. Rotational delivery of the fetus: Kielland's forceps and two other methods compared. Br J Obstet Gynaecol 1982; 89: 501506.Google Scholar
23Rodrigues, C, Singh, PM, Gupta, AN. Kielland's forceps for deep transverse arrest. Asia Oceania J Obstet Gynaecol 1983; 9: 159–62.CrossRefGoogle ScholarPubMed
24Cardozo, LD, Gibb, DM, Studd, JW, Cooper, DJ. Should we abandon Kielland's forceps? Br Med J 1983; 287: 315–17.Google Scholar
25Traub, AI, Morrow, RJ, Ritchie, JW, Dornan, KJ. A continuing use for Kielland's forceps? Br J Obstet Gynaecol 1984; 91: 894–98.CrossRefGoogle ScholarPubMed
26Hastie, SJ, MacLean, AB. Comparison of the use of the silastic obstetric vacuum extractor to Kielland's forceps. Asia Oceania J Obstet Gynaecol 1986; 12: 6368.CrossRefGoogle ScholarPubMed
27Herabutya, Y, O-Prasertsawat, P, Boonrangsimant, P. Kielland's forceps or ventouse–a comparison. Br J Obstet Gynaecol 1988; 95: 483–87.CrossRefGoogle ScholarPubMed
28Svigos, JM, Cave, DG, Vigneswaran, R, Resch, A, Christiansen, J. Silastic cup vacuum extractor or forceps: a comparative study. Asia Oceania J Obstet Gynaecol 1990; 16: 32–27.CrossRefGoogle ScholarPubMed
29Gleeson, NC, Gormally, SM, Morrison, JJ, O'Regan, M. Instrumental rotational delivery in primiparae. Ir Med J 1992; 85: 139–41.Google ScholarPubMed
30Jain, V, Guleria, K, Gopalan, S, Narang, A. Mode of delivery in deep transverse arrest. Int J Gynaecol Obstet 1993; 43: 129–35.CrossRefGoogle ScholarPubMed
31Krivak, TC, Drewes, P, Horowitz, GM. Kielland vs. nonrotational forceps for the second stage of labor. J Reprod Med 1999; 44: 511–17.Google Scholar
32Hankins, GD, Leicht, T, Van Hook, J, Uckan, EM. The role of forceps rotation in maternal and neonatal injury. Am J Obstet Gynecol 1999; 180: 231–34.CrossRefGoogle ScholarPubMed
33Schiff, E, Friedman, SA, Zolti, M, Avraham, A, Kayam, Z, Mashiach, S et al. A matched controlled study of Kielland's forceps for transverse arrest of the fetal vertex. J Obstet Gynaecol 2001; 21: 576–79.CrossRefGoogle ScholarPubMed
34Olagundoye, V, MacKenzie, IZ. The impact of a trial of instrumental delivery in theatre on neonatal outcome. BJOG 114: 603608.Google Scholar
35Al-Suhel, R, Gill, S, Robson, S. Shadbolt B. Kjelland's forceps in the new millennium. Maternal and neonatal outcomes of attempted rotational forceps delivery. Aust N Z J Obstet Gynaecol 2009; 49: 510–14.CrossRefGoogle ScholarPubMed
36Leo, MV, Leo, MV, Odibo, A, Ling, PY, Rodis, J, Borgida, A, et al. Transverse arrest: a review of outcomes of rotational forceps and cesarean delivery at a single center. Prim Care Update Ob Gyns 1998; 5: 186.CrossRefGoogle ScholarPubMed
37Bashore, R A, Phillips, WHJ, Brinkman, CRR. A comparison of the morbidity of midforceps and cesarean delivery. Am J Obstet Gynecol 1990; 162: 1428–34; discussion 1434–5.CrossRefGoogle ScholarPubMed
38Fredrikson, H. Mid and high forceps deliveries with Kielland's forceps. Acta Obstet Gynecol Scand 1956 35: 464–82.CrossRefGoogle ScholarPubMed
39Singh, K, Viegas, O, Heng, SH, Ratnam, SS. An eight year experience with the use of Kielland's forceps in Singapore. Singapore Med J 1986; 27: 225–29.Google ScholarPubMed
40Chow, SL, Johnson, CM, Anderson, TD, Hughes, JH. Rotational delivery with Kielland's forceps. Med J Aust 1987; 146: 616–19.CrossRefGoogle ScholarPubMed
41Tan, KH, Sim, R, Yam, KL. Kielland's forceps delivery: is it a dying art? Singapore Med J 1992; 33: 380–82.Google Scholar
42Hinton, L, Ong, S., Danielian, PJ.Kiellands forceps delivery–quantification of neonatal and maternal morbidity. Int J Gynaecol Obstet 2001; 74: 289–91.CrossRefGoogle ScholarPubMed
43Liddiard, A, Ayaz, H, Mallalah, A, Elsapagh, K. Kielland's forceps deliveries: Short-term maternal and neonatal morbidity. J Obstet Gynaecol 2010; 30: 759–60.Google Scholar
44Fernando, RJ, Williams, AA, Adams, EJ. The management of third and fourth degree perineal tears. RCOG Greentop Guideline 2007: 29.Google Scholar
46RCOG. Operative vaginal delivery - Consent Advice. Consent Advice 11, 2010.Google Scholar
47Majoko, F., Gardener, G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database Syst Rev 2008; CD005545.Google Scholar
48Caesarean section. NICE clinical Guideline 2011; 132.Google Scholar
49Liu, S, Liston, RM. Joseph KS, Heaman M, Sauve R, Kramer, Michael. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176: 455–60.CrossRefGoogle ScholarPubMed
50Bahl, R, Strachan, B, Murphy, DJ. Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study. Br Med J 2004; 328: 311.Google Scholar
51Chinnock, M, Robson, S. An anonymous survey of registrar training in the use of Kjelland's forceps in Australia. Aust N Z J Obstet Gynaecol 2009; 49: 515–16.CrossRefGoogle ScholarPubMed
52Ramin, SM, Little, BB, Gilstrap LCR. Survey of forceps delivery in North America in 1990. Obstet Gynecol 1993; 81: 30–11.Google Scholar
53Robson, S, Pridmore, B. Have Kielland forceps reached their ‘use by’ date? Aust N Z J Obstet Gynaecol 1999; 39: 301304.CrossRefGoogle ScholarPubMed
54RCOG. Survey of Training 2002. RCOG, London 2003.Google Scholar
55RCOG. Survey of Training 2008. RCOG, London 2009.Google Scholar