Ophthalmic findings following noticeable external injury following forceps delivery
Reviewed by Lauren Hepworth

This study prospectively recruited consecutive women following a forceps vaginal delivery of a single foetus in cephalic position over a two-year period. Individual patient consent was waived by the approving body. The neonates received a paediatrician assessment soon after birth. Urgent ophthalmology referral was made for those identified to have external bruising or abrasions. Ophthalmology assessed anterior and posterior segment within 48 hours of birth. Any required treatment was recorded. A total of 77 deliveries met the inclusion criteria within the time period. A quarter had external injuries noted and were referred to ophthalmology. There were no significant difference between the groups identified with external injuries and those not in terms of gestational age at delivery, labour duration, birthweight, admission for intensive care and the training level of the obstetrician. There were significantly more needing ophthalmology assessment who had a head position right or left occipital (sagittal suture within 45 degrees from the midline of the forceps). Of those referred for ophthalmic assessment, seven cases were found to have no ophthalmic injuries. The most common injuries detected were dot retinal haemorrhages or subconjunctival haemorrhages. Three were identified to have non-ophthalmic injuries. The study findings are in line with current information given in the informed consent process for forceps delivery. The authors provide advice of position adjustment to avoid the most risky placement of the forceps to avoid injury.

A prospective study on neonatal ophthalmic injuries associated with forceps delivery.
Kong CW, To WWK, Lai THT, et al.
JOURNAL OF THE AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS
2023;27:196.