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Forceps or vacuum extraction? A comparison of effects on the newborn infant.

Sixteen women delivered by forceps and 20 women delivered by vacuum extraction (VE) owing to secondary uterine inertia were compared with a control group of 11 women who gave birth spontaneously. The cord arterial pH was lower in the VE group than in the forceps and control groups. Base deficit in both arterial and venous cord blood was greater in the VE group than in the forceps group, probably owing to the longer application and extraction times in VE than in forceps delivery. The incidence of retinal hemorrhage did not differ between the forceps and VE groups. The incidence of cephalhematomata was greater among VE infants than in the forceps and control groups. All infants were examined on the 1st and 5th day by standardized neurological and behavioural examination. There were no significant differences in neurological status between the forceps and VE groups. Thus, in low extraction with no signs of fetal asphyxia, either method can be used with safety if the obstetrician is familiar with both methods of operative vaginal delivery.

Adult↗

Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women.

OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.

Adult↗

[Value of the preventive use of antibiotics following vaginal obstetric operations].

For a period of 6 years 838 puerperal cases after vaginal obstetric operations (forceps delivery, vacuum extraction, delivery with speculum, manual placenta separation, palpation of the uterus) were critically analysed. The result of the studies suggest that an antibiotic or chemoprophylaxis after vaginal obstetric operations is not successful because of the relatively low infectious morbidity. In obstetrics this prophylaxis is indicated only in delivery by caesarean section as a perioperative short-time prophylaxis.

Chloramphenicol↗

Failed trial of vacuum or forceps--maternal and fetal outcome.

OBJECTIVE: Our purpose was to compare the maternal and neonatal morbidity associated with a failed trial of instrumental delivery with that of proceeding directly to cesarean section during the second stage of labor. STUDY DESIGN: All second-stage cesarean deliveries between January 1986 and December 1992 in a tertiary care teaching hospital were retrospectively reviewed. Specific maternal and neonatal outcome parameters were studied to compare the failed instrumental group with the direct-to-cesarean section group. RESULTS: Of 29,457 live births at > 37 weeks' gestation, 401 women had a cesarean section performed in the second stage of labor. There were 326 cases in which cesarean section was performed directly during the second stage of labor and 75 women who had a failed attempt of instrumental delivery (forceps 33, vacuum 25, both 17) before cesarean delivery was done. The three instrumental groups and the direct-to-cesarean section group did not differ in any of the outcome variables for either mother or newborn. CONCLUSIONS: Failed instrumental delivery performed as a trial of forceps and/or vacuum in a setting where a cesarean section can follow promptly is not associated with increased morbidity of either mother or baby.

Cesarean Section↗

Cohort study of maternal and neonatal morbidity in relation to use of episiotomy at instrumental vaginal delivery.

OBJECTIVE: The aim of this study was to investigate the maternal and neonatal morbidity related to use of episiotomy for vacuum and forceps deliveries. DESIGN: Retrospective population-based cohort study. SETTING: Dundee, Scotland. POPULATION: Two thousand one hundred and fifty three women who experienced an instrumental vaginal delivery between January 1998 and December 2002. METHODS: Univariate and multivariate logistic regression analyses were performed comparing deliveries with and without the use of episiotomy. MAIN OUTCOME MEASURES: Extensive perineal tears (third and fourth degree) and shoulder dystocia. RESULTS: Two hundred and forty-one (11%) of the 2153 women who underwent instrumental vaginal deliveries did not receive an episiotomy. Vacuum delivery was associated with less use of episiotomy compared with forceps (odds ratio 0.10, 95% CI 0.07-0.14). Extensive perineal tears were more likely with use of episiotomy (7.5%vs 2.5%, adjusted OR 2.92, 95% CI 1.27-6.72) as was neonatal trauma (6.0%vs 1.7%, adjusted OR 2.62, 95% CI 1.05-6.54). Use of episiotomy did not reduce the risk of shoulder dystocia (6.9%vs 4.6%, adjusted OR 1.43, 95% CI 0.74-2.76). The findings were similar for delivery by vacuum and forceps. CONCLUSION: The use of episiotomy increased the risk of extensive perineal tears without a reduction in the risk of shoulder dystocia.

Cohort Studies↗

A randomised prospective study comparing the new vacuum extractor policy with forceps delivery.

OBJECTIVE: To compare assisted vaginal delivery by forceps with delivery by vacuum extractor, where a new vacuum extractor policy was employed which dictated the cup to be used in specific situations. DESIGN: Multicentre randomised controlled trial. SETTING: Four district general hospitals in the West Midlands. SUBJECTS: Six hundred-seven women requiring assisted vaginal delivery, of whom 296 were allocated to vacuum extractor delivery and 311 to forceps. MAIN OUTCOME MEASURES: Delivery success rate, maternal perineal and vaginal injuries, maternal anaesthetic requirements, neonatal scalp and facial injuries. RESULTS: Of the vacuum extractor group, 85% were delivered by the allocated instrument compared to 90% in the forceps group (odds ratio (OR) 0.64; 95% confidence intervals (CI) 0.4-1.04). However, more women in the vacuum extractor group were delivered vaginally (98%) than in the forceps group (96%). There were significantly fewer women with anal sphincter damage or upper vaginal extensions in the vacuum extractor group (11% vs 17%, OR 0.6; 95% CI, 0.38-0.97). There were significantly fewer women in the vacuum extractor group requiring epidural or spinal anaesthetics (25.4% vs 32.7%, OR 0.69; 95% CI 0.49-0.99) or general anaesthetics (1% vs 4%, OR 0.17; 95% CI 0.04-0.76). Although there were significantly more babies in the vacuum extractor group with cephalhaematomata (9% vs 3%, OR 3.3; 95% CI 1.4-7.4) there were fewer babies in the vacuum extractor group with other facial injuries. There were three babies in the forceps group with unexplained neonatal convulsions. CONCLUSIONS: Assisted vaginal delivery using the new vacuum extractor policy is associated with significantly less maternal trauma than with forceps. Further studies are required to assess neonatal morbidity adequately.

Adult↗

Second stage of labour with or without extradural analgesia.

Two groups of parturients who had received selective extradural analgesia were studied. In Group A patients the regional block was allowed to wear off for the second stage of labour whereas in Group B patients' analgesia was maintained throughout labour. The maintenance of selective analgesia was of positive benefit to the mothers. They experienced much less pain, labour was not prolonged, dosage of bupivacaine was not increased, the forceps delivery rate was lower and there were fewer persistent malrotations.

Adult↗

Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.

OBJECTIVE: To analyze the instrumental deliveries carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia during the year 2000 and compare the outcome of ventouse and forceps deliveries. METHODS: A retrospective case note review of all instrumental deliveries, carried out at the Armed Forces Hospital, Riyadh, during the year 2000. RESULTS: Three hundred and four vaginal deliveries, of whom 258 were ventouse and 46 were forceps deliveries, were assisted. Seventy percent of forceps deliveries were carried out in primigravida as compared to 49% of ventouse deliveries. Fetal distress was the indication in 81.4% of ventouse deliveries as compared to 76% of forceps deliveries. Prolonged 2nd stage of labor was an indication in 11% of forceps and 2.3% of ventouse deliveries. Consultants and Senior Registrars were more likely to use forceps while registrars use ventouse as their preferred instrument for delivery. Attempted ventouse delivery was successful in 91.4% as compared to 95.7% in forceps. Extension of an episiotomy was more likely to occur with ventouse than forceps deliveries while 3rd degree perineal tear occurred more with forceps deliveries. Babies who had attempted ventouse deliveries have lower apgar score at one minute than attempted forceps. No babies required admission to neonatal intensive care unit. There was only one stillbirth in the ventouse delivery group due to intrapartum asphyxia and true knot in the umbilical cord. CONCLUSION: Forceps is more likely to be used in the primigravida and prolonged 2nd stage of labor and less likely to fail. Ventouse is more likely to be used by registrars. Extension of an episiotomy and low apgar score at one minute is more likely to occur with ventouse deliveries.

Adult↗