{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:12:43Z","timestamp":1792293163318,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T00:00:00Z","timestamp":1375833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Wellbeing of Women (WoW) Research Training Fellowship"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the maternal and neonatal morbidity associated with alternative instruments used to perform a mid\u2010cavity rotational delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Two university teaching hospitals in <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>cotland and <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ngland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Three hundred and eighty\u2010one nulliparous women who had a mid\u2010cavity rotational operative vaginal delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A data collection sheet was completed by the research team following delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Postpartum haemorrhage, third\u2010 and fourth\u2010degree perineal tears, low cord <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>, neonatal trauma, and failed or sequential operative vaginal delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and sixty\u2010three women (42.8%) underwent manual rotation followed by non\u2010rotational forceps delivery, 73 (19.1%) had a rotational vacuum delivery, and 145 (38.1%) delivered with the assistance of rotational (<jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ielland) forceps. The rates of postpartum haemorrhage were similar when comparing manual rotation with rotational vacuum (adjusted OR\u00a01.42, 95%\u00a0CI 0.66\u20133.98), and when comparing manual rotation with <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ielland forceps (adjusted OR\u00a01.22, 95%\u00a0CI 0.71\u20132.88). The results were comparable for third\u2010 and fourth\u2010degree perineal tears (adjusted OR\u00a00.85, 95%\u00a0CI 0.13\u20131.89; adjusted OR\u00a00.94, 95%\u00a0CI 0.39\u20131.82), low cord <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content> (adjusted OR\u00a01.76, 95%\u00a0CI 0.44\u20136.91; adjusted OR\u00a01.12, 95%\u00a0CI 0.44\u20132.83), neonatal trauma (adjusted OR\u00a00.50, 95%\u00a0CI 0.16\u20131.55; adjusted OR\u00a03.25, 95%\u00a0CI 0.65\u201316.17), and admission to the neonatal intensive care unit (adjusted OR\u00a01.47, 95%\u00a0CI 0.45\u20134.81; adjusted OR\u00a01.04, 95%\u00a0CI 0.49\u20132.19). The sequential use of instruments was less likely with manual rotation and forceps than with rotational vacuum delivery (0.6 versus 36.9%, OR\u00a00.01, 95%\u00a0CI 0.002\u20130.090).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Maternal and perinatal outcomes are comparable with <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ielland forceps, vacuum extraction, and manual rotation, with few serious adverse outcomes. With appropriate training mid\u2010cavity rotational delivery can be practiced safely, including the use of <jats:styled-content style=\"fixed-case\">K<\/jats:styled-content>ielland forceps.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12398","type":"journal-article","created":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T15:09:35Z","timestamp":1375888175000},"page":"1526-1533","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Maternal and neonatal morbidity in relation to the instrument used for mid\u2010cavity rotational operative vaginal delivery: a prospective cohort study"],"prefix":"10.1111","volume":"120","author":[{"given":"R","family":"Bahl","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Van de Venne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Royal United Hospital Bath UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Macleod","sequence":"additional","affiliation":[{"name":"Division of Maternal and Child Health Sciences Ninewells Hospital &amp; Medical School University of Dundee Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Strachan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology St Michael's Hospital Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DJ","family":"Murphy","sequence":"additional","affiliation":[{"name":"Academic Department of Obstetrics &amp; Gynaecology Coombe Women &amp; Infants University Hospital &amp; Trinity College University of Dublin Dublin UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,8,7]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"139","article-title":"Instrumental rotational delivery in primiparae","volume":"85","author":"Gleeson NC","year":"1992","journal-title":"Ir Med J"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38971.466979.DE"},{"key":"e_1_2_7_4_1","first-page":"28","article-title":"High risk labour","volume":"7","author":"Friedman EA","year":"1971","journal-title":"J Repro Med"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(77)90257-5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.6155.7"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2009.01058.x"},{"key":"e_1_2_7_8_1","first-page":"41","article-title":"The obstetric vacuum extractor is the instrument of first choice for operative vaginal delivery","volume":"9","author":"Chalmers JA","year":"1996","journal-title":"BJOG"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.OGX.0000086420.13848.89"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00508.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.06.035"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06341-3"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ajog.2007.03.034","article-title":"Neurodevelopmental outcome at 5\u00a0years after operative delivery in the second stage of labor: a cohort study","volume":"197","author":"Bahl R","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01960.x"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01961.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.01.004"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117309"},{"key":"e_1_2_7_18_1","volume-title":"Management of third and fourth degree perineal tears following vaginal delivery","author":"Fernando RJ","year":"2007"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-0528.2003.02173.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.547"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-200108000-00008"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-0528.2003.01463.x"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2009.01060.x"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/01443610120085500"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1987.tb120438.x"},{"key":"e_1_2_7_26_1","first-page":"CD000C24","article-title":"Vacuum extraction versus forceps for assisted vaginal delivery","volume":"11","author":"Johanson RB","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00729.x"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00834.x"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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