[Some considerations on forceps delivery with excenter handle (author's transl)].

The introduction of electronic monitoring techniques in delivery increasingly has lead to the use of vaginal surgery in delivery. Vacuum and forceps extraction, in our view, do not compete with each other. Years ago forceps extraction was decisively improved by introducing the axial traction forceps. However, we believe that this technique has not been given due attention and is not applied widely enough. In vacuum extraction and in forceps deliveries without axial traction considerable part of the force is exerted in the direction of the symphysis. When using the excentric handle forceps, it is necessary in addition to the traction and pressure components to include the lever action. This is a so-called couple of forces. The additional torque involved in the use of an axial traction forceps shifts the fetal head during extraction in the direction of the hollow of the sacrum. The force needed for this shift and the progression of the head is many times less than that required for conventional forceps extraction. This is due to the absence of the component directed at the symphysis which impedes delivery. The axial traction forceps may also be used in case of the infant's abnormal positioning of the head. In case of a transverse position of the fetal head, a special fastener on the forceps makes it possible to use an excentric handle on the traction hook of the Kielland forceps and thus render possible rotation of the fetal head from the transverse position. The extentric handle in forceps extraction is optimal in order to overcome increased mechanical resistance to delivery. Adjustment of the handles to all types of forceps being used today is possible. From the results mentioned it is clear that the use of the axial traction forceps constitutes a valuable contribution toward declining perinatal mortality rates.