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MRCPI,
Katie Field,
MRCPI,
Fakhra Mujahid,
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MRCOG,
MD, FRCOG
Burke et al
occipitoposterior, and for the occipitotransverse position, the anterior blade was applied by a technique of
careful wandering of the blade over the fetal face
into position with direct application of the posterior
blade. After rotation, the delivery was completed
using the Kiellands forceps. During the time period
of the study (19972011), the overall operative delivery rates in the institution were as follows: the average
forceps rate was 5.4% (1997, 10%; 2011, 5.5%); the
average vacuum-assisted delivery rate was 13.2%
(1997, 8.6%; 2011, 12%); and the average cesarean
delivery rate was 24.8% (1997, 18.3%; 2011, 29.2%).
Microsoft Excel was used to tabulate and graphically summarize the data. The statistical package
SPSS 18 was used to perform descriptive statistics.
Finally, a logistic regression analysis for trend was
performed to examine for any potential variation in
the number of cases per year during the study.
RESULTS
During the time period of the study there were 45,335
neonates delivered, and Kiellands forceps was attempted in 144 cases (0.3%), leading to a successful
assisted delivery for 129 neonates, 89.6% (95% confidence interval [CI] 8394%), and a failed attempt in
15 cases (10.4%) (95% CI 6 17%). The results concerning the 15 cases of failed attempt at delivery are
outlined separately at the end of this section.
For successfully assisted delivery with Kiellands
forceps, the number of cases per year during the time
period of the study varied from three to 21 with a
mean of 8.6 cases (Fig. 1). There was no significant
linear increase or decrease observed in the number of
cases per year for the duration of the study (95% CI
0.931.02, P.266). The vast majority of women for
whom Kiellands forceps-assisted delivery took place
were nulliparous (n116; 89.9%), and the remaining
were parous women (n13; 10.1%). The mean age of
the group was 31.9 years (3.9, standard error of the
mean [SEM]) with a range in age from 20 43 years.
The rate of induction of labor for this group was
44.2% (n57), and the remaining 55.8% (n72) underwent spontaneous onset of labor. The indications
for forceps-assisted delivery were as follows: delayed
second stage of labor (n94; 72.9%) and suspected
fetal compromise (n35; 27.1%).
The BMI details of the 129 women delivered
using Kiellands forceps are demonstrated in Table 1.
It is evident that 48% (n59) were in the normal BMI
category with 2% (n2) in the low-weight category,
and 50% of the women (n61) were either overweight or obese (in seven cases the BMI was not
recorded). The mean duration of labor was 10 hours
767
25
20
15
10
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
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DISCUSSION
The findings from this study indicate that use of the
Kiellands forceps for assisted rotational vaginal
delivery, in selected circumstances, in current obstetric practice, with the fetal head mainly at the
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