Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Abstract

Objective This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes.

Study Design This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls.

Results Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application.

Conclusion The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls.

Keywords

operative vaginal delivery - forceps - vacuum - pop-offs - pulls - duration

Note

These findings were presented at the Society for Maternal-Fetal Medicine annual meeting in Atlanta, GA, 2016.

^* See [Supplementary Material] (available in the online version) for a list of other members of the NICHD MFMU Network.

• References

• 1 Operative vaginal delivery. ACOG Technical Bulletin Number 196-- August 1994 (replaces No. 152, February 1991). Int J Gynaecol Obstet 1994; 47 (02) 179-185
• 2 Bofill JA, Rust OA, Devidas M, Roberts WE, Morrison JC, Martin Jr JN. Neonatal cephalohematoma from vacuum extraction. J Reprod Med 1997; 42 (09) 565-569
• 3 Bofill JA, Rust OA, Schorr SJ, Brown RC, Roberts WE, Morrison JC. A randomized trial of two vacuum extraction techniques. Obstet Gynecol 1997; 89 (5 Pt 1): 758-762
• 4 Murphy DJ, Liebling RE, Patel R, Verity L, Swingler R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG 2003; 110 (06) 610-615
• 5 Grobman WA, Bailit JL, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study. Am J Obstet Gynecol 2014; 211 (02) 147.e1-147.e16
• 6 Hook CD, Damos JR. Vacuum-assisted vaginal delivery. Am Fam Physician 2008; 78 (08) 953-960
• 7 Castro MA, Hoey SD, Towner D. Controversies in the use of the vacuum extractor. Semin Perinatol 2003; 27 (01) 46-53
• 8 Boo NY, Foong KW, Mahdy ZA, Yong SC, Jaafar R. Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. BJOG 2005; 112 (11) 1516-1521
• 9 Mollberg M, Hagberg H, Bager B, Lilja H, Ladfors L. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstet Gynecol 2005; 106 (5 Pt 1): 913-918
• 10 Teng FY, Sayre JW. Vacuum extraction: does duration predict scalp injury?. Obstet Gynecol 1997; 89 (02) 281-285
• 11 Bailit JL, Grobman WA, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals. Am J Obstet Gynecol 2013; 209 (05) 446.e1-446.e30