Thorp, John M., Jr. (2014). Reintroducing Kielland Forceps. BJOG: An International Journal of Obstetrics & Gynaecology, 121(5)
t is always reassuring to find that the conclusions made in a contemporary article in a biomedical journal mirror the conclusions and decision made in a judicial review. Tempest et al. recently reported on over 1200 forceps, ventouse, or manual rotations performed in mothers with arrest of descent, with the fetal head not in an occiput anterior position (BJOG 2013;120:1277–84). They conclude that ‘assisted vaginal birth by Keilland forceps is likely to be the safest and most effective’ mode of delivery. In 2007 the Scottish Court of Sessions ruled in a case in which a transverse arrest of descent was treated with a trial of rotational forceps that failed (Dinley versus Lothian Health Board). The birth was completed abdominally and the baby went on to develop encephalopathy, and ultimately, cerebral palsy. The plaintiff alleged negligence both in the decision to try a forceps rotation and the conduct of the operation itself. Lord Hodge weighed the evidence and expert opinions, and concluded that even though some experts consider that a trial of forceps was not appropriate, a substantial volume of medical literature supports this approach as safe and effective. Moreover, the excellent documentation by the operating clinician established that the requirements for such a rotational delivery to be appropriate had been met, and the procedure was performed properly. The doctor and health facility were found not guilty of negligence.
BJOG: An International Journal of Obstetrics & Gynaecology
Thorp, John M., Jr.