Clinical Case Database / Category: Clinical Care
Operative vaginal delivery: Are forceps always better than a Kiwi Omnicup?
Hayser Medina Lucena, MBChB, MRCOG,, Harnek Rai, MBChB, MRCOG, FRANZCOG,
Foundation Years Journal, volume 8, issue 7, p.21 (123Doc Education, London, July 2014)
After centuries of use in obstetrics, have forceps and vacuum deliveries become a dying art? For example, following a number of poor outcomes with Kiellandâ€™s forceps in the 1970s, their use has no longer been taught to obstetricians, with the result that usage was abandoned in some units, while rigorous training and use continued elsewhere (1). Contemporary trends in operative vaginal delivery show increasing numbers of vacuum deliveries and corresponding decreasing numbers of forceps deliveries worldwide (2). In the UK the overall rate of operative vaginal deliveries is between 10 and 13%. This rate has remained stable over many years compared with caesarean section rates, which have continued to climb. It is difficult to determine exactly why forceps have fallen out of fashion and been replaced by Ventouse (vacuum). Although Kiwi Omnicup (vacuum delivery) is associated with less perineal trauma, it has a higher failure rate than forceps. Could this be contributing to the caesarean-section increase rate? A safe operative vaginal delivery requires careful assessment of the clinical situation, clear communication with the patient and healthcare personnel and operator expertise in the chosen procedure. It is crucial to anticipate any complication such as shoulder dystocia, postpartum haemorrhage or an obstetric anal sphincter injury.
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Hayser Medina Lucena, MBChB, MRCOG,
ST4 in Obstetrics and Gynaecology, West Suffolk Hospital,
Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ
Harnek Rai, MBChB, MRCOG, FRANZCOG,
Consultant Gynaecologist, Peterborough and
Stamford Hospital NHS Foundation Trust, Edith Cavell Campus,
Bretton Gate, Peterborough, Cambridgeshire, PE3 9GZ
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