Introduction of forceps delivery education for residents at a single perinatal institution

Abstract

Background: The Japan Society of Obstetrics and Gynecology (JSOG) guidelines, revised in 2013, recommend that the numbers of traction should be at most five repetitions in vacuum extraction. Forceps extraction is less likely to fail compared with vacuum extraction and requires less equipment and preparation. At our institution, forceps delivery was not a standard procedure, but in response to revisions of the JSOG guidelines, we launched an education program on forceps delivery for residents in January 2013. We report the results of introduced delivery at our institution. Methods: An education program for residents covering forceps delivery was introduced at our institution in January 2013. We conducted a retrospective review of medical records of 108 patients who had deliveries by either forceps or vacuum extraction from January 2013 through July 2015 in our institution. We compared maternal and neonatal outcomes between forceps and vacuum deliveries for all cases as well as those delivered by trainees. Results: The rates of forceps and vacuum deliveries performed by trainees were 60.9% and 50.0%, respectively. Two or more tractions were required in 18/62 (29.0%) of vacuum deliveries vs. 3/46 (6.5%) of forceps deliveries. There was significantly more bleeding in forceps deliveries compared with vacuum deliveries (616.3 ± 322.3 g vs. 465.2 ± 274.9 g). There was one failed vaginal delivery in each group. The rate of cephalohematoma was significantly higher in vacuum deliveries (12/62, 19.4%) vs. forceps deliveries (1/46, 2.17%). Facial abrasion caused by the equipment was significantly more frequent in forceps deliveries (6/46, 13.0%) vs. vacuum deliveries (1/62, 1.6%). Similar results were found between all cases and cases delivered by trainees. Conclusion: Forceps delivery was introduced as a clinical practice that is as safe as vacuum delivery. It is conceivable that training and indication for forceps delivery were of importance.