A primigravida at term is fully dilated with dense epidural block. The vertex is at 0 station in direct occipito-transverse position and has remained there for 2 hours despite adequate contractions and maternal pushing. There is no caput or moulding and the pelvis is assessed as adequate. Which instrument is specifically designed for the operative correction of this situation?

• A Wrigley's outlet forceps
• B Piper's forceps
• C Simpson's forceps
• D Kielland's forceps ✓

Explanation

Kielland's forceps have sliding locks, minimal pelvic curvature and directional buttons, features designed specifically for rotating a malrotated vertex such as deep transverse arrest and delivering it. Simpson's forceps have a pronounced pelvic curve suited to traction in an occipito-anterior position, Wrigley's are light outlet forceps, and Piper's are applied to the aftercoming head in breech delivery. This scenario of deep transverse arrest with an adequate pelvis is the classic Kielland indication.

Reference: Munro Kerr's Operative Obstetrics, 13th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.