Operative vaginal delivery in singleton term pregnancies: Short-term maternal and neonatal outcomes

4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece.
Hippokratia (Impact Factor: 0.37). 02/2009; 13(1):41-5.
Source: PubMed


The rate of operative vaginal delivery has remained stable the last decade, however the rate of vacuum has increased against forceps application. Different maternal and neonatal outcomes have been proposed by many reports. The aim of the present study is to compare the short term maternal and neonatal outcomes between vacuum and forceps delivery.
We conducted a medical record review of live born singleton, vacuum and forceps-deliveries. Maternal and delivery characteristics were recorded. Maternal and neonatal outcomes were also assessed. Out of 7098 deliveries, 374 were instrument assisted, 324 were conducted by vacuum (86.7%) and 50 by forceps (13.3%).
The incidence of 3rd degree lacerations and periurethral hematomas was similar between vacuum and forceps (3.4% vs. 2% and 0.3% vs 0% respectively), while perineal hematomas were more common in forceps compared with vacuum application (2% vs 0.3% respectively), albeit not significantly. The rate of neonates with Apgar scores<or=at 1 min was significantly higher after forceps compared with vacuum delivery (18% vs 5.2% respectively, p=0.0003). The same observation was made concerning the neonatal intensive care unit (NICU) admissions (38% vs 11% respectively, p=0.0001). The rate of neonatal trauma and respiratory distress syndrome did not differ significantly between the two groups.
Results of the present study indicate that both modes of instrumental vaginal delivery are safe with respect to maternal morbidity and neonatal trauma. However, forceps application increases the risk of neonatal compromise consequently necessitating their admission in the NICU.

Download full-text


Available from: Sophia Masoura, Jan 27, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Instrumental deliveries are believed to be associated with increased maternal and, especially, fetal morbidity and mortality. Hence, it is less practiced in many developing countries. The aim of this retrospective study, conducted between 1 January 2007 and 31 December 2008, was to assess the prevalence, indications, neonatal wellbeing and maternal complications of instrumental deliveries. Of 3623 vaginal deliveries, 84 (2.3%) instrumental deliveries were conducted. The most common indication was a prolonged second stage of labour. Fetal wellbeing, measured by the Apgar score, was good and was similar in the group who had forceps delivery and that of the vacuum extraction delivery group. Maternal complications, usually minor, were vaginal and perineal tears. Instrumental delivery should be encouraged and taught in order to reverse the rising caesarean section rate.
    No preview · Article · Oct 2010 · Tropical Doctor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery. Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 120 cases were included in this prospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, instrumental injuries, NICU admissions PNM etc. χ(2) test was used to analyze the data. Maternal morbidity viz. episiotomy extension as well as first and second degree perineal tear were significant in the forceps group (P = 0.0001 and P = 0.02, respectively). With regards to neonatal morbidity, no statistically significant difference was noted. Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.
    Preview · Article · Dec 2011
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Mothers delivering as private patients in Australia have a high rate of assisted deliveries, which could lead to adverse infant outcomes in this group of patients. We investigated whether the risk of adverse infant outcomes after assisted deliveries was different for mothers admitted as public or private patients for delivery, when compared with unassisted deliveries. We included 158,241 vaginal, singleton, term birth admissions in our study where the infant was live born and without birth defects. The study population was identified from statutory birth and hospital data collections held by the Western Australian (WA) Department of Health. We estimated odds ratios and confidence intervals using logistic regression models adjusted for a range of maternal demographic, pregnancy and birth characteristics. Interaction was assessed by including interaction terms in the models. Outcomes included low Apgar scores at five minutes (<7), neonatal resuscitation and special care admission. Mothers delivering as private patients had an increased risk of assisted vaginal delivery compared with public patients (adjusted OR 1.74, 95% CI = 1.68-1.80). Compared with unassisted vaginal deliveries, assisted deliveries were associated with increased risk of Apgar scores at five minutes below 7 (OR 1.25, 1.08-1.45), neonatal resuscitation (OR = 1.69, 1.42-2.00) and admission to special care nursery (OR = 1.64, 1.53-1.76). The increased risk of neonatal resuscitation was higher for mothers admitted as private patients for delivery (OR = 2.13) than public patients (OR = 1.55, p(interaction) = 0.03). Our results suggested that the high risk of neonatal resuscitation following assisted vaginal deliveries compared to unassisted is higher in private patients than public patients. Whether this phenomenon is due to the twofold higher rate of assisted vaginal deliveries in this group of patients or a higher rate of fetal indications for assisted vaginal delivery remains to be answered.
    Full-text · Article · Apr 2013 · PLoS ONE
Show more