Kielland's forceps delivery: is it a dying art?

A retrospective study in the use of Kielland's Forceps for rotation of the foetal head and mid-cavity delivery in Kandang Kerbau Hospital, Singapore from 1987-1990 is presented. Out of a total of 53,889 singleton births during this period, Kielland's Forceps was used for delivery in 137 (0.25%) patients with an incidence of 0.65% in the primiparae and 0.07% in the multiparae. Primiparity, induction of labour and epidural analgesia were associated with a significantly higher incidence of rotational delivery by Kielland's forceps. The success rate of Kielland's forceps delivery was 93.4% (128 of 137). There was no maternal or perinatal mortality. About one-third of the mothers experienced postpartum morbidity, commonest being retention of urine, postpartum haemorrhage and vaginal lacerations. Traumatic injuries were present in about one-quarter of the babies and were minor. Out of a total of 306 mid-cavity deliveries for occipito-transverse malposition, Kielland's forceps accounted for 38.2% (117), vacuum extraction 30.7% (94), manual rotation followed by Neville-Barnes forceps 11.1% (34) and Caesarean section 20.0% (61). The junior specialists tended to use vacuum extraction for rotational delivery more than the senior specialists.