Published: 2018-04-28

Comparative study to identify the safety, effectiveness and ease of obstetric forceps for delivery of floating head in cesarean section

Sonali Jitendra Ingole, Saloni Manwani


Background: Difficulty is frequently encountered in extraction of floating fetal head. This study will focus on comparison of Forceps assisted fetal head extraction during Lower segment caesarean section (LSCS) with manual method of extraction in LSCS.

Methods: The ANC patients attending antenatal OPD and admitted for elective caesarean section fulfilling the inclusion criteria were randomly divided into two groups each of 400 patients: Group 1 of patients undergoing manual extraction of fetal head during LSCS; and Group 2 consisting of patients with forceps assisted delivery of fetal head in LSCS. Following factors will be evaluated in patients: maternal blood loss, any extension of uterine incision, difference in pre and post op hemoglobin levels of the patient and Apgar score of baby at 1 and 5 minutes.

Results: Patients in both the groups were matched demographically. The demographic variables such as maternal age, weight, parity and MGA (Mean Gestational age) were comparable in both the groups. Blood loss was significant in Group 1 (manual delivery) as compared with Forceps assisted delivery. This is also reflected in difference in pre and post op Hemoglobin levels. Although baby outcome in terms of Apgar score was similar in both groups, however morbidity in terms of uterine artery trauma, extension of uterine incision was much less in group 2 (Forceps assisted LSCS delivery)

Conclusions: Although there was no statistically significant difference in outcome of babies (APGAR score), complication(s) were less (blood loss, uterine artery trauma) in Forceps assisted LSCS delivery group. Proper selection of patient(s), early anticipation for application for Forceps can help for better outcome of caesarean delivery.


Cesarean section, Delivery, Forceps

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Declercq E, Young R, Cabral H, Ecker J. Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth. 2011;38(2):99-104.

Sritippayawan S, Chantrapitak W. Assisted delivery of high floating fetal head: a comparison of vacuum- assisted delivery with manual extraction. Asian Biomed. 2011;5:699-703.

Khurshid N, Sadiq F. Management of primigravida with unengaged head at term. PJMHS. 2012;6(1):36-9.

Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ open. 2014;4(12):e005982.

Hoogsteder PH, Pijnenborg JM. Use of uterine fundal pressure maneuver at vaginal delivery and risk of severe perineal laceration. Arch Gynecol Obstet. 2010;281(3):579-80.

Nakano R. Use of the vacuum extractor for delivery of the fetal head at cesarean section. Am J Obstet Gynecol. 1981;141(4):475-6.

Shashank S, Neena R, Singh JR. A prospective randomized study comparing maternal and fetal effects of forceps delivery and vacuum extraction. J Obstet Gynecol India. 2013;63(2):116-9.

Warenski JC. A technique to facilitate delivery of the high-floating head at cesarean section. American journal of obstetrics and gynecology. 1981;139(6):625-7.

Bofill JA, Lencki SG, Barhan S, Ezenagu LC. Instrumental delivery of the fetal head at the time of elective repeat cesarean: a randomized pilot study. Am J Perinatol. 2000;17(5):265-9.

Levy R, Chernomoretz T, Appleman Z. Head pushing versus reverse breech extraction in cases of impacted fetal head during cesarean section. Eur J Obstet Gynecol Reprod Biol. 2005;12:24.

Waterfall H, Grivell RM, Dodd JM. Techniques for assisting difficult delivery at caesarean section. Cochrane Database Syst Rev. 2016;1:CD004944.

Sujata S, Sagarika N, Satpathy RN, Purna M. Assisted delivery of mobile fetal head: a comparison of forceps, vaccum and assisted manual extraction of head at caesarean section. Int J Reprod Contracept Obstet Gynecol. 2017;6(9):4065-70.