Rotational vaginal delivery with Kielland's forceps: a systematic review and meta-analysis of effectiveness and safety outcomes.
OBJECTIVE
The use of Kielland's forceps has declined significantly in the last three decades. There is a lack of quality evidence on potential benefits and harms associated with using these forceps. We have performed a systematic review of the literature and meta-analysis to assess the safety and efficacy of using Kielland's forceps.


RESULTS
We have searched electronic databases for all clinical studies reporting primary data on using Kielland's forceps and assessed their risk of bias using the Newcastle-Ottawa Scale. We have pooled the event rate of adverse outcomes reported following the use of Kielland's forceps including a direct comparison to rotational ventouse. In total we included 23 studies. Direct comparison meta-analysis revealed higher failure rate with rotational ventouse compared with Kielland's. There was no statistically significant difference in the risk of adverse maternal outcomes between the two groups. There was higher risk of neonatal trauma in the ventouse group, but no significant difference in other neonatal outcomes.


CONCLUSIONS
Kielland's forceps have a high success rate with relatively low adverse outcomes despite their use being controversial. In comparison to rotational ventouse, Kielland's forceps have higher efficacy with less risk of neonatal trauma.
aWomen's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London bBirmingham Women's NHS Foundation Trust cBirmingham University, Birmingham, UK.
Bassel H
BH
Al Wattar
Baihas
B
Al Wattar
Ioanis
I
Gallos
Alexander M
AM
Pirie
D001003:Anal Canal / Q000293:injuries*; D001720:Birth Injuries / Q000209:etiology / Q000517:prevention & control*; D036861:Delivery, Obstetric; D019317:Evidence-Based Medicine; D005113:Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000628:therapy*; D009772:Obstetrical Forceps / Q000009:adverse effects; D061214:Patient Safety; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D018570:Risk Assessment