BJOG Exchange

DOI: 10.1111/1471-0528.12602 www.bjog.org

Rotational forceps training needs to be scaled up

Sir, We read with great interest the retrospective review by Tempest et al.1 on the favourable outcomes with Kiellands forceps in Liverpool. We wish to reinforce the message that use of Kiellands forceps can achieve higher vaginal delivery rates with no extra increase in maternal and fetal morbidity by looking at our audit of Kiellands forceps deliveries performed by the first author. Following his arrival at St Thomas’ Hospital, London in mid-2009 there was a >20% reduction in potentially morbid second-stage caesarean sections in a year from 207 to 160 cases. This correlated with the first author increasing the Kiellands deliveries from 45 to 158. In total, he performed 292 (75%) of the Kiellands deliveries in the hospital until early 2013. Analysis of the first 249 deliveries revealed a low 4% failure rate compared with other studies reporting between 5 and 10% (9/249). The neonatal and maternal morbidity was also correspondingly low with 4% thirddegree tears (8/249), 1.6% vaginal tears (4/249), 1.5% of cases with a fetal cord pH