Forceps delivery in modern obstetric practice

Forceps delivery and complications

1 June 2004

The review article by Patel and Murphy gives a concise and clear overview of the current state of play regarding the use of forceps in modern obstetric practice. The article addresses the issue of third degree tears, but does not discuss the occult sphincter injury that may lead to symptoms later in life. The incidence of endosonographic sphincter damage following forceps delivery has been reported in 83% of forceps deliveries when studied prospectively, and this was supported by manometric abnormalities in these patients (1). Faecal incontinence which develops in women in later life (age 60-70 years) has been associated with previous obstetric sphincter injury in 70% of patients, in whom a sphincter defect can be demonstrated ultrasonongraphically (2). There is thus a cohort of women who will have an occult sphincter injury that will only develop symptoms later in life. Women undergoing forceps delivery should be warned of this possibility.

1. Varma A, Gunn J, Gardiner A, Lindow SW, Duthie GS. Obstetric anal sphincter injury: prospective evaluation of incidence. Dis Colon Rectum. 1999 Dec;42(12):1537-43.

2. Oberwalder M, Dinnewitzer A, Baig MK, Thaler K, Cotman K, Nogueras JJ, Weiss EG, Efron J, Vernava AM 3rd, Wexner SD. The association between late-onset fecal incontinence and obstetric anal sphincter defects. Arch Surg. 2004 Apr;139(4):429-32.

Competing interests: None declared

Competing interests: None declared

Peter Goodfellow, Specialist Registrar

Sheffield Teaching Hospitals S5 7AU

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