From the Guidelines
Luikart forceps are not indicated for obstetric use, as they are associated with greater maternal tissue damage, including levator ani muscle injury, symptomatic prolapse, and incontinence, as well as longer-term symphyseal or pelvic girdle pain 1. The use of forceps in obstetrics is a complex issue, with various factors influencing the decision to use them. However, the latest evidence suggests that forceps delivery is associated with increased maternal morbidity, particularly in terms of mechanical injury to the pelvic floor and surrounding tissues.
- Key considerations for obstetric procedures include:
- Minimizing tissue damage and trauma to the pelvic floor
- Reducing the risk of symptomatic prolapse and incontinence
- Avoiding longer-term complications, such as symphyseal or pelvic girdle pain
- Prioritizing alternative approaches that promote safer and more effective delivery outcomes According to the study published in The Lancet Global Health 1, the use of forceps in obstetrics can have significant long-term consequences for women's health, emphasizing the need for careful consideration and caution when deciding on their use.
- Important factors to consider in obstetric care include:
- Labour duration and the potential for interventions
- The impact of intrinsic and extrinsic factors on labour and childbirth-related complications
- The importance of preventive measures to reduce the burden of chronic conditions arising from labour and childbirth In light of these findings, it is essential to prioritize alternative approaches to obstetric care that minimize the risk of maternal morbidity and promote optimal outcomes for women's health 1.
From the Research
Indications for Luikart (Obstetric) Forceps
The indications for Luikart (obstetric) forceps include:
- Prolonged labor 2, 3, 4
- Suspected fetal distress 2, 3
- Maternal medical conditions that benefit from a shortened second stage of labor 2
- Fetal asphyxia 3
- Arrest of the head in the same plane of the pelvis 3
- Ineffective uterine contractions and/or pushes 3
- Avoiding maternal efforts in the second stage of labor 3
- Malpositions 3
- Preeclampsia-eclampsia 3
- Genital bleeding 3
- Prolapse of the umbilical cord 3
- Poor maternal effort 4
Specific Considerations
- Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma 2
- Second-stage caesarean section is associated with less fetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth 2
- Midcavity forceps are associated with a greater incidence of obstetric anal sphincter injury 5
- The risk for adverse outcomes is minimized when the procedure is conducted by a skilled accoucheur who selects the most appropriate instrument likely to achieve vaginal birth with the primary instrument 5