Maternal and neonatal complications following Kielland's rotational forceps delivery: A systematic review and meta-analysis

Abstract

Background: There is conflicting evidence regarding the safety of Kielland's rotational forceps delivery (KRFD) in comparison with other modes of delivery for the management of persistent fetal malposition in the second stage of labour.

Objectives: To derive estimates of risks of maternal and neonatal complications following KRFD, compared with rotational ventouse delivery (RVD), non-rotational forceps delivery (NRFD) or a second-stage caesarean section (CS), from a systematic review and meta-analysis of the literature.

Search strategy: Standard search methodology, as recommended by the Cochrane Handbook for Systematic Reviews of Interventions.

Selection criteria: Case series, prospective or retrospective cohort studies and population-based studies.

Data collection and analysis: A meta-analysis using a random-effects model was used to derive weighted pooled estimates of maternal and neonatal complications.

Main results: Thirteen studies were included. For postpartum haemorrhage there was no significant difference between Kielland's and ventouse delivery; the rate was lower in Kielland's delivery compared with non-rotational forceps (RR 0.79, 95% CI 0.65-0.95) and second-stage CS (RR 0.45, 95% CI 0.36-0.58). There were no differences in the rates of anal sphincter injuries or admission to neonatal intensive care. Rates of shoulder dystocia were higher with Kielland's delivery compared with ventouse delivery (RR 1.79, 95% CI 1.08-2.98), but rates of neonatal birth trauma were lower (RR 0.49, 95% CI 0.26-0.91). There were no differences seen in the rates of 5-min APGAR score < 7 between Kielland's delivery and other instrumental births, but they were lower when compared with second-stage CS (RR 0.47, 95% CI 0.23-0.97).

Conclusions: Kielland's rotational forceps delivery is a safe option for the management of fetal malposition in the second stage of labour.

Keywords: Kielland's forceps; birth trauma; fetal malposition; postpartum haemorrhage; rotational forceps delivery.