Kielland's forceps. From controversy to consensus?

Kielland's rotational forceps are designed to overcome malposition of the fetal head in the second stage of labor. After a decline in their use because of reported adverse outcomes and fear of litigation, recent evidence suggests that they may be safe and effective in trained hands and significantly more successful at achieving operative vaginal delivery than either rotational ventouse or manual rotation. This is important because of the increased short and long-term morbidity related to cesarean section compared with the reduced morbidity of subsequent pregnancy after operative vaginal delivery. Kielland's forceps are therefore re-emerging as a useful instrument in the armamentarium of modern obstetrics. Limitations to wider use of Kielland's forceps are the lack of training opportunities as well as that contemporary evidence remains underpowered to detect rare adverse outcomes.