Mode of Delivery in Nulliparous Women and Neonatal Intracranial Injury

Abstract

OBJECTIVE To compare neonatal neurologic complication rates of cesarean deliveries, forceps-assisted vaginal deliveries, and vacuum-assisted vaginal deliveries. METHODS Data on singleton live births at 34 weeks or greater gestation born to nulliparous women from 1995 to 2003 in New York City were linked to hospital discharge data. Any diagnosis of neonatal subdural hemorrhage, intraventricular hemorrhage, seizures, scalp laceration or cephalohematoma, fracture, facial nerve palsy, brachial plexus injury, or 5-minute Apgar score of less than 7 was considered significant. Multivariable logistic regression was used to estimate associations between delivery mode and these neonatal morbidities. RESULTS Forceps-assisted vaginal deliveries were associated with significantly fewer seizures and 5-minute Apgar scores less than 7 compared with vacuum-assisted vaginal deliveries and cesarean deliveries. Cesarean deliveries were linked to less subdural hemorrhages compared with forceps-assisted vaginal deliveries or vacuum-assisted vaginal deliveries. When seizure, intraventricular hemorrhage, and subdural hemorrhage were examined collectively to best predict neurologic outcome, forceps-assisted vaginal deliveries had an overall reduced risk compared with both vacuum-assisted vaginal deliveries (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.40–0.90) and cesarean deliveries (OR 0.68, 95% CI 0.48–0.97). The number needed to treat to prevent one case of severe neurologic morbidity is 509 for forceps-assisted vaginal deliveries compared with vacuum-assisted vaginal deliveries and 559 for forceps-assisted vaginal deliveries compared with cesarean deliveries. CONCLUSION Compared with vacuum-assisted vaginal delivery or cesarean delivery, a forceps-assisted vaginal delivery is associated with a reduced risk of adverse neonatal neurologic outcomes.

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

“…This is in line with the results of previous studies [10,12,14] . Regarding the distribution of 5-min Apgar values, there were more 5-min Apgar values ≤ 5 in the CS group.…”

“…Regarding the distribution of 5-min Apgar values, there were more 5-min Apgar values ≤ 5 in the CS group. A previous investigation [14] also presented a higher rate of Apgar scores (<7) in the CS group than deliveries by forceps. Another study [12] demonstrated a higher percentage of 5-min Apgar scores (<7) regardless of the indication for delivery in their CS group in comparison to instrumentalassisted deliveries, but the differences were not significant.…”

“…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] .…”

Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality: An expert opinion

“…Several retrospective studies comparing neonatal morbidity after CD v. AVD have been published. Werner et al [16] found that forceps deliveries were associated with a significantly reduced risk of adverse neonatal neurological outcome (when regarding seizures and intraventricular and subdural haemorrhage as the morbidities most predictive of future neurodevelopmental deficits). Forceps delivery was also IPA+T rate, /1 000 Ventouse deliveries, % Fig.…”

Evaluation of delivery options for second-stage events

“…56, 7 However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. The appropriate clinical comparison is cesarean versus operative vaginal delivery.…”