Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor

Abstract

Objective To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor. Methods Retrospective study of 2,518 women carrying singleton fetuses at ≥37 weeks gestation who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit {ICU} admission) and a neonatal adverse outcome composite (5 minute Apgar<4, respiratory morbidity, neonatal intensive care unit {NICU} admission, shoulder dystocia, birth trauma, or sepsis). Results In nulliparous patients the maternal adverse composite was not significantly different between women who underwent attempted forceps (12.1% vs.10.8%,aOR 0.77,95%CI 0.40–1.34) or vacuum (8.3% vs. 10.8%,aOR 0.68,95%CI 0.40–1.16) delivery compared to cesarean delivery. Among parous women, the maternal adverse composite was not significantly different with attempted forceps (10.7% vs. 12.5%,aOR 0.40,95%CI 0.09–1.71) or vacuum (11.3% vs. 12.5%,aOR 0.44,95%CI 0.11–1.72) compared to cesarean delivery. Compared to infants delivered by cesarean, the neonatal adverse composite was significantly lower among infants born to nulliparous women who underwent attempted forceps (9.4% vs. 16.7%,aOR 0.44,95%CI 0.27–0.72) but not among those who underwent vacuum delivery (11.9% vs. 16.7%,aOR 0.68,95%CI 0.44–1.04). Among parous women, the neonatal adverse composite was not significantly different after attempted forceps (4.1% vs 12.5%,aOR 0.28,95%CI 0.06–1.35) or vacuum (12.5% vs. 12.5%,aOR 1.03,95%CI 0.28–3.87) compared to cesarean delivery. Conclusion A trial of forceps delivery from a low station compared to cesarean delivery was associated with decreased neonatal morbidity among infants born to nulliparous women.

Neonatal and Maternal Short-Term Outcome Parameters in Instrument-Assisted Vaginal Delivery Compared to Second Stage Cesarean Section in Labour: A Retrospective 11-Year Analysis

“…However, the procedure-related definition of increased blood loss leads to higher rates in instrumental delivery, even if the mean blood loss estimated in ml is higher in CS. These results are in contradiction to previous ones, as there were no significant differences for maternal hemorrhage [10,11] . Differently used cut-off definitions for high blood loss or hemorrhage within studies make comparisons of data difficult, as for example in one study a significant hemorrhage was defined as the need for blood transfusion [10] .…”

“…An earlier study described the highest rates of short-term neonatal and maternal complications after instrumental-assisted delivery compared to vaginal delivery and CS in labour [10] . However, a recent study presented contradictory results [11] showing no differences for maternal adverse outcome parameters, and even demonstrated a lower neonatal adverse outcome among nulliparous women who delivered forceps-assisted delivery [11] . Another study demonstrated that neonates born by CS in labour are also vulnerable to intracranial trauma [15] .…”

“…Only few studies directly addressed the differences between maternal and neonatal short-term outcomes after instrumental vaginal or cesarean delivery. The existing literature is either contradictory [10,11] or assesses the neonatal outcome in isolation [12][13][14] . An earlier study described the highest rates of short-term neonatal and maternal complications after instrumental-assisted delivery compared to vaginal delivery and CS in labour [10] .…”

The relationship between the five minute Apgar score, mode of birth and neonatal outcomes

“…There is some evidence that babies delivered by caesarean section (CS) have lower Apgar scores in comparison to those delivered vaginally [11] with a higher risk after emergency procedures.…”

Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station

“…6 The literature on perinatal and maternal mortality and morbidity after operative vaginal delivery compared with cesarean delivery is inconsistent. [7][8][9][10][11][12][13][14][15][16] In addition, studies on the risks and benefits of these Increased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery.…”