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Am J Perinatol 2010; 27(6): 493-499
DOI: 10.1055/s-0030-1247605
© Thieme Medical Publishers

Neonatal Outcomes and Operative Vaginal Delivery Versus Cesarean Delivery

Stephen A. Contag1 , Rebecca G. Clifton2 , Steven L. Bloom3 , Catherine Y. Spong4 , Michael W. Varner5 , Dwight J. Rouse6 , Susan M. Ramin7 , Steve N. Caritis8 , Alan M. Peaceman9 , Yoram Sorokin10 , Anthony Sciscione11 , Marshall W. Carpenter12 , Brian M. Mercer13 , John M. Thorp14 , Fergal D. Malone15 , Jay D. Iams16
  • 1Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, North Carolina
  • 2George Washington University Biostatistics Center, Washington, D.C.
  • 3University of Texas Southwestern Medical Center, Dallas, Texas
  • 4Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
  • 5University of Utah, Salt Lake City, Utah
  • 6University of Alabama at Birmingham, Birmingham, Alabama
  • 7University of Texas at Houston, Houston, Texas
  • 8University of Pittsburgh, Pittsburgh, Pennsylvania
  • 9Northwestern University, Chicago, Illinois
  • 10Wayne State University, Detroit, Michigan
  • 11Drexel University, Philadelphia, Pennsylvania
  • 12Brown University, Providence, Rhode Island
  • 13Case Western Reserve University, Cleveland, Ohio
  • 14University of North Carolina, Chapel Hill, North Carolina
  • 15Columbia University, New York, New York
  • 16The Ohio State University, Columbus, Ohio
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Publication History

Publication Date:
22 January 2010 (online)

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ABSTRACT

We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at ≥36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (p = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (p = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

KEYWORDS

Cesarean - forceps - umbilical cord blood gases - vacuum

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Stephen A ContagM.D. 

Institute for Maternal Fetal Medicine, Department of Obstetrics and Gynecology

Sinai Hospital, 2401 West Belvedere Ave, Baltimore, MD 21215; reprints are not available from the author

Email: scontag@lifebridgehealth.org