What are the maternal and neonatal outcomes after Keilland’s forceps delivery compared with other modalities?
This meta-analysis of observational studies published since 2000 suggests that KRFD is a relatively safe mode of delivery in singleton births as compared with RVD, NRFD, and second-stage CS. No reported maternal or neonatal outcomes were significantly worse with KRFD, and several were better than with one or more of the other modalities. These included rates of postpartum hemorrhage (vs NRFD and CS), neonatal birth trauma (vs RVD), and APGAR score less than 7 at 5 minutes (vs CS). Randomized controlled trials are needed. Studies like this may be helpful to overcome concerns about the medicolegal risk of forceps delivery with rotation.
This is a meta-analysis of 13 observational studies published in English between 2000 and June 2022 on maternal and neonatal outcomes after Keilland’s rotational forceps delivery (KRFD) used in singleton births. The authors were unable to identify any randomized controlled trials on this topic. They sought to compare maternal and neonatal outcomes after KRFD with those of rotational ventouse delivery (RVD), nonrotational forceps delivery with or without manual rotation (NRFD), and second-stage cesarean delivery (CD). The meta-analysis included 9 retrospective cohorts, 2 prospective cohorts, 1 matched case-control study, and 1 case series. There was no significant difference in the rate of postpartum hemorrhage (PPH, defined variously in the studies) for KRFD versus RVD (relative risk [RR] 0.87; 95% CI 0.68 - 1.11; P = .257), and lower rates of PPH versus NRFD (RR 0.79; 0.65 - 0.95; P = .012) and CD (RR 0.45; 0.36 - 0.58; P < .001). There were no differences in the rates of obstetric anal sphincter injury between KRFD and RVD or NRFD (comparison with CD was not reported). Regarding neonatal outcomes, there were no significant differences in neonatal admissions to intensive care among KRFD and the other 3 modalities. There was a significantly lower rate of neonatal birth trauma after KRFD than after RVD (RR 0.49; 0.26 - 0.91; P = .24) and no difference as compared with NRFD. There was a lower rate of an APGAR score of less than 7 at 5 minutes with KRFD versus CS (RR 0.47; 0.23 - 0.97; P = .04) and no significant differences compared with the other 2 modalities. The authors did not find evidence of publication bias.
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo