eMedicine Specialties > Obstetrics and Gynecology > Labor and Delivery

Forceps Delivery: Follow-up

Author: Michael G Ross, MD, MPH, Professor of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles; Professor, Department of Community Health Sciences, University of California at Los Angeles School of Public Health; Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Coauthor(s): Marie Helen Beall, MD, Clinical Professor, Geffen School of Medicine, University of California at Los Angeles; Vice Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Contributor Information and Disclosures

Updated: Dec 18, 2008

Outcome and Prognosis

The use of forceps has been associated with long-term maternal and fetal morbidity. The remaining question is whether the association implies causality. In one study, the use of forceps electively was not associated with an increase in maternal or fetal morbidity in patients who were randomly assigned to delivery spontaneously or by forceps.17 Unfortunately, this study contained only 50 patients and thus was underpowered to find the kind of serious morbidities described. This study also does not address the more frequent case, in which forceps delivery is used urgently as an alternative to cesarean delivery.

Future and Controversies

The future of forceps deliveries is in doubt. Information developed in the 1980s suggests that fetal outcome may be poor after at least some forceps deliveries. Other data suggest that long-term compromise of the maternal rectal sphincter is a common sequela of forceps delivery. In view of the discussions of the merits of cesarean delivery on demand for preservation of maternal pelvic musculature, the place of forceps deliveries in obstetrical practices has been questioned.

Given the current state of knowledge, it is the position of the American College of Obstetrics and Gynecology that forceps delivery remains an acceptable and safe option for delivery.3 However, recent birth certificate data from the United States reports a total forceps rate of 1.6%, about one third of which (0.6%) were unsuccessful.18  This suggests that experience and skill with forceps has become difficult to obtain, leading to concerns about the survival of the procedure.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Aram Bonni, MD, to the development and writing of this article.



More on Forceps Delivery

Overview: Forceps Delivery
Workup: Forceps Delivery
Treatment: Forceps Delivery
Follow-up: Forceps Delivery
Multimedia: Forceps Delivery
References
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References

  1. Hale R. Dennen's Forceps Deliveries. 4th ed. Philadelphia, Pa: FA Davis; 2001.

  2. Bofill JA, Rust OA, Perry KG, et al. Operative vaginal delivery: a survey of fellows of ACOG. Obstet Gynecol. Dec 1996;88(6):1007-10. [Medline].

  3. American College of Obstetricians and Gynecologists. American College of Obstetricians and Gynecologists Practice Bulletin. Operative Vaginal Delivery. Washington, DC: American College of Obstetricians and Gynecologists; June, 2000.

  4. Leslie KK, Dipasquale-Lehnerz P, Smith M. Obstetric forceps training using visual feedback and the isometric strength testing unit. Obstet Gynecol. Feb 2005;105(2):377-82. [Medline].

  5. Youssef R, Ramalingam U, Macleod M, Murphy DJ. Cohort study of maternal and neonatal morbidity in relation to use of episiotomy at instrumental vaginal delivery. BJOG. Jul 2005;112(7):941-5. [Medline].

  6. Johnson JH, Figueroa R, Garry D, Elimian A, Maulik D. Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. Obstet Gynecol. Mar 2004;103(3):513-8. [Medline].

  7. Hirsch E, Haney EI, Gordon TE, Silver RK. Reducing high-order perineal laceration during operative vaginal delivery. Am J Obstet Gynecol. Jun 2008;198(6):668.e1-5. [Medline].

  8. Pretlove SJ, Thompson PJ, Toozs-Hobson PM, Radley S, Khan KS. Does the mode of delivery predispose women to anal incontinence in the first year postpartum? A comparative systematic review. BJOG. Mar 2008;115(4):421-34. [Medline].

  9. Donnelly V, Fynes M, Campbell D, et al. Obstetric events leading to anal sphincter damage. Obstet Gynecol. Dec 1998;92(6):955-61. [Medline].

  10. de Leeuw JW, de Wit C, Kuijken JP, Bruinse HW. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. BJOG. Jan 2008;115(1):104-8. [Medline].

  11. Towner DR, Ciotti MC. Operative vaginal delivery: a cause of birth injury or is it?. Clin Obstet Gynecol. Sep 2007;50(3):563-81. [Medline].

  12. Dupuis O, Silveira R, Redarce T, et al. [Instrumental extraction in 2002 in the "AURORE" hospital network: incidence and serious neonatal complications]. Gynecol Obstet Fertil. Nov 2003;31(11):920-6. [Medline].

  13. Caughey AB, Sandberg PL, Zlatnik MG, et al. Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol. Nov 2005;106(5 Pt 1):908-12. [Medline].

  14. Towner D, Castro MA, Eby-Wilkens E, Gilbert WM. Effect of mode of delivery in nulliparous women on neonatal intracranial injury. N Engl J Med. Dec 2 1999;341(23):1709-14. [Medline].

  15. Gardella C, Taylor M, Benedetti T, et al. The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes. Am J Obstet Gynecol. Oct 2001;185(4):896-902. [Medline].

  16. Bhide A, Guven M, Prefumo F, Vankalayapati P, Thilaganathan B. Maternal and neonatal outcome after failed ventouse delivery: comparison of forceps versus cesarean section. J Matern Fetal Neonatal Med. Jul 2007;20(7):541-5. [Medline].

  17. Carmona F, Martinez-Roman S, Manau D, et al. Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American College of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies. Am J Obstet Gynecol. Jul 1995;173(1):55-9. [Medline].

  18. Menacker F, Martin JA. Expanded health data from the new birth certificate, 2005. Natl Vital Stat Rep. Feb 29 2008;56(13):1-24. [Medline].

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Further Reading

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Keywords

forceps delivery, operative delivery, forceps application, trial of forceps, assisted delivery, breech delivery, Simpson forceps, Tucker-McLane forceps, obstetrics, gynecology, Piper forceps, forceps-assisted delivery, breech presentation, operative vaginal delivery, assisted delivery, invasive delivery, pelvic application, delivery complications, difficult delivery, problem delivery, low-forceps delivery, outlet-forceps delivery, high-forceps delivery, midforceps delivery, mid forceps

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Contributor Information and Disclosures

Author

Michael G Ross, MD, MPH, Professor of Obstetrics and Gynecology, David Geffen School of Medicine, University of California at Los Angeles; Professor, Department of Community Health Sciences, University of California at Los Angeles School of Public Health; Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Michael G Ross, MD, MPH is a member of the following medical societies: American Association for the Advancement of Science, American College of Obstetricians and Gynecologists, American Federation for Clinical Research, American Gynecological and Obstetrical Society, American Physiological Society, American Public Health Association, Association of Professors of Gynecology and Obstetrics, Perinatal Research Society, Phi Beta Kappa, Society for Gynecologic Investigation, Society for Maternal-Fetal Medicine, and Society for Neuroscience
Disclosure: Nothing to disclose.

Coauthor(s)

Marie Helen Beall, MD, Clinical Professor, Geffen School of Medicine, University of California at Los Angeles; Vice Chair, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center
Marie Helen Beall, MD is a member of the following medical societies: American College of Medical Genetics, American College of Obstetricians and Gynecologists, and American Society of Human Genetics
Disclosure: Nothing to disclose.

Medical Editor

Suzanne R Trupin, MD, Clinical Professor of Obstetrics and Gynecology, University of Illinois College of Medicine-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center
Suzanne R Trupin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
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