Clinical Review

Forceps delivery in modern obstetric practice

BMJ 2004; 328 doi: (Published 27 May 2004) Cite this as: BMJ 2004;328:1302

Forceps delivery and complications

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: No competing interests

01 June 2004
Peter Goodfellow
Specialist Registrar
Sheffield Teaching Hospitals S5 7AU