Browse the corpus

The use of forceps in infant delivery has declined sharply in the United States, with only about 0.98% of vaginal births involving forceps in 2023. Despite reduced utilization, forceps-assisted delivery remains a vital obstetric skill, offering a safe alternative to cesarean delivery when used appropriately. This course reviews this technique, which requires a thorough knowledge of maternal pelvic anatomy, fetal position and station, and the criteria for operative vaginal delivery. Participants will also gain an in-depth understanding of proper assessment of pelvimetry, fetal head engagement, and maternal and fetal contraindications, ensuring safety and optimal outcomes. This activity explores evidence-based recommendations for forceps delivery, including indications, contraindications, procedural techniques, and management of complications, as well as the assessment of labor progress, identification of appropriate candidates, and safe, effective operative vaginal delivery strategies. This activity for healthcare professionals is designed to enhance the learner's competence in performing forceps deliveries, employing the recommended techniques, managing complications, and implementing an appropriate interprofessional approach in patients undergoing this procedure, ultimately improving maternal and neonatal outcomes while reducing unnecessary cesarean deliveries. Objectives: Identify appropriate indications for forceps-assisted delivery Apply evidence-based techniques for effective forceps application. Evaluate potential complications associated with operative vaginal delivery. Collaborate with interprofessional teams to optimize maternal and neonatal outcomes in patients undergoing forceps application. Access free multiple choice questions on this topic.

The use of forceps in infant delivery has declined significantly in the United States over the past 3 decades. In 2023, forceps deliveries accounted for approximately 0.98% of vaginal births, while vacuum extraction comprised about 0.68% of all deliveries.[1] This downward trend is attributed to multiple factors, including fear of litigation, limited training opportunities, and the increasing complexity of pregnancies. Despite these challenges, operative vaginal delivery with forceps remains a valuable skill. When applied correctly during the second stage of labor arrest, forceps can reduce the need for cesarean delivery, which carries higher risks of complications, eg, infection, hemorrhage, and uterine rupture (see Image. Forceps Delivery).[2] Additionally, a meta-analysis indicated that a previous cesarean delivery increases the risk of spontaneous preterm birth in subsequent pregnancies, whereas operative vaginal delivery does not.[3]

Accurately determining complication rates associated with forceps deliveries remains challenging because most studies lack adequate control groups. Despite this limitation, consistent trends in maternal and neonatal complications have been documented across available research. Maternal complications with the use of forceps-assisted deliveries include a higher incidence of perineal and vaginal lacerations, hematomas, and anal sphincter injuries compared with vacuum deliveries.[15] Furthermore, long-term maternal complications, including pelvic organ prolapse and pelvic floor dysfunction, occur more frequently in cases involving severe perineal trauma. Women with a history of forceps delivery face an increased risk of levator ani muscle injury, anal sphincter damage, and other forms of pelvic floor dysfunction years after childbirth.[16][17] For neonates, most complications following forceps delivery tend to be mild and temporary, eg, facial bruising, superficial lacerations, or facial nerve palsy. More serious outcomes, including ocular trauma, skull fractures, intracranial hemorrhage, and subgaleal hematomas, occur infrequently but may arise during difficult or rotational deliveries. A recent systematic review of Kielland rotational forceps demonstrated that rotational techniques resulted in fewer overall birth injuries than nonrotational forceps or second-stage cesarean deliveries, although shoulder dystocia occurred more frequently in these cases.[18]

Forceps-assisted delivery, though declining in the United States, remains a critical obstetric skill that provides a safe alternative to cesarean delivery when maternal or fetal conditions necessitate operative intervention. Proper use requires a thorough understanding of maternal pelvic anatomy, fetal position, and station, as well as the ability to identify absolute and relative contraindications. Mastery of evidence-based techniques minimizes maternal trauma, reduces neonatal injury, and optimizes labor outcomes. Clinicians must balance procedural proficiency with careful patient assessment to ensure safety and effectiveness during the second stage of labor. Effective patient-centered care in operative vaginal delivery relies on coordinated skills and communication among the interprofessional team. Physicians and advanced practitioners lead assessment and procedural execution, while nurses monitor maternal and fetal status and provide essential support during labor. Neonatal clinicians are critical when neonatal resuscitation is required. Pharmacists ensure the appropriate administration of analgesia and manage medications, while general practitioners may assist in follow-up care. Clear communication and collaborative decision-making enhance patient safety, reduce complications, and improve team performance, ensuring optimal maternal and neonatal outcomes.[19]