title: A re-evaluation of the role of rotational forceps: retrospective comparison of maternal and perinatal outcomes following different methods of birth for malposition in the second stage of labour.
abstract: OBJECTIVE
  To compare the outcomes of operative cephalic births by Kielland forceps (KF), rotational ventouse (RV), or primary emergency caesarean section (pEMCS) for malposition in the second stage of labour in modern practise.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Data were included from 1291 consecutive full-term, singleton cephalic births between 2 November 2006 and 30 November 2010 with malposition of the fetal head during the second stage of labour leading to an attempt to deliver by KF, RV or pEMCS.
  
  
  METHODS
  Maternal and neonatal outcomes of all KF births were compared with other methods of operative birth for malposition in the second stage of labour (RV or pEMCS).
  
  
  METHODS
  Achieving a vaginal birth was the primary outcome and fetal (admission to special care baby unit, low cord pH, low Apgar, shoulder dystocia, Erb's palsy) and maternal (massive obstetric haemorrhage-blood loss of >1500 ml, sphincter injury, length of stay in hospital) safety outcomes were also recorded.
  
  
  RESULTS
  Women were more likely to need caesarean section if RV (22.4%) was selected to assist the birth rather than KF (3.7%; adjusted odds ratio 8.20; 95% confidence interval 4.54-14.79). Births by KF had a rate of adverse maternal and neonatal outcomes comparable to those by RV and pEMCS in the second stage for malposition.
  
  
  CONCLUSIONS
  Our results suggest that, in experienced hands, assisted vaginal birth by KF is likely to be the most effective and safe method to prevent the ever rising rate of caesarean sections when malposition complicates the second stage of labour.
authors.affiliation: Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: N
authors.initials: N
authors.lastname: Tempest
authors.forename: A
authors.initials: A
authors.lastname: Hart
authors.forename: S
authors.initials: S
authors.lastname: Walkinshaw
authors.forename: D K
authors.initials: DK
authors.lastname: Hapangama
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology; D020516:Brachial Plexus Neuropathies / Q000209:etiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004420:Dystocia / Q000209:etiology; D004630:Emergencies; D005113:Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015931:Intensive Care, Neonatal; D007746:Labor Presentation; D007748:Labor Stage, Second; D007902:Length of Stay; D009772:Obstetrical Forceps / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Emergency caesarean section; Kielland forceps; rotational vaginal birth; rotational ventouse