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The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes

      Abstract

      Objective: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery. Study Design: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries. Results: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations. Conclusion: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury. (Am J Obstet Gynecol 2001;185:896-902.)

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      References

        • Graves EJ
        • Kozak LJ
        National hospital discharge survey: annual summary, 1996.
        Vital Health Stat 13. 1999; 140: 1-46
        • Johanson RB
        • Rice C
        • Doyle M
        • Arthur J
        • Anyanwu L
        • Ibrahim J
        • et al.
        A randomised prospective study comparing the new vacuum extractor policy with forceps delivery.
        Br J Obstet Gynaecol. 1993; 100: 524-530
        • Yancey MK
        • Herpolsheimer A
        • Jordan GD
        • Benson WL
        • Brady K
        Maternal and neonatal effects of outlet forceps delivery compared with spontaneous vaginal delivery in term pregnancies.
        Obstet Gynecol. 1991; 78: 646-650
        • Ezenagu LC
        • Kakaria R
        • Bofill JA
        Sequential use of instruments at operative vaginal delivery: is it safe?.
        Am J Obstet Gynecol. 1999; 180: 1446-1449
        • Combs CA
        • Robertson RA
        • Laros RK
        Risk factors for thirddegree and fourth-degree perineal lacerations in forceps and vacuum deliveries.
        Am J Obstet Gynecol. 1990; 163: 100-104
        • Teng FY
        • Sayre JW
        Vacuum extraction: does duration predict scalp injury.
        Obstet Gynecol. 1997; 89: 281-285
        • Bofill JA
        • Rust OA
        • Devidas M
        • Roberts WE
        • Morrison JC
        • Martin Jr, JN
        Neonatal cephalohematoma from vacuum extraction.
        J Reprod Med. 1997; 42: 565-569
        • Huang LT
        • Lui CC
        Tentorial hemorrhage associated with vacuum extraction in a newborn.
        Pediatr Radiol. 1995; 25: S230-S231
        • Hickey K
        • McKenna P
        Skull fracture caused by vacuum extraction.
        Obstet Gynecol. 1996; 88: 671-673
        • Plauche WC
        Fetal cranial injuries related to delivery with the Malmstrom vacuum extractor.
        Obstet Gynecol. 1979; 53: 750-757
        • Towner D
        • Castro MA
        • Wilkens EE
        • Gilbert WM
        Effect of mode of delivery in nulliparous women on neonatal intracranial injury.
        N Engl J Med. 1999; 341: 1709-1714
        • Parrish DM
        • Holt VL
        • Connell FA
        • Williams B
        • LoGerfo JP
        Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989.
        Am J Epidemiol. 1993; 138: 119-127
        • Van de Riet JE
        • Vandenbusche F
        • LeCessie S
        • Keirse JN
        Newborn assessment and long-term adverse outcome: a systematic review.
        Am J Obstet Gynecol. 1999; 180: 1024-1029
        • Williams RL
        • Creasy RK
        • Cunningham GC
        • Hawes WE
        • Norris FD
        • Tashiro M
        Fetal growth and perinatal viability in California.
        Obstet Gynecol. 1982; 59: 624-632
        • Nocon JJ
        • McKenzie DK
        • Thomas LJ
        • Hansell RS
        Shoulder dystocia: an analysis of risks and obstetric maneuvers.
        Am J Obstet Gynecol. 1993; 168: 1732-1737
        • McFarland LV
        • Raskin M
        • Daling JR
        • Benedetti TJ
        Erb/Duchenne's palsy: a consequence of fetal macrosomia and method of delivery.
        Obstet Gynecol. 1986; 68: 784-788
        • Ecker JL
        • Greenberg JA
        • Norwitz ER
        • Nadel AS
        • Repke JT
        Birth weight as a predictor of brachial plexus injury.
        Obstet Gynecol. 1997; 89: 643-647
        • Johanson RB
        • Heycock E
        • Carter J
        • Sultan AH
        • Walklate K
        • Jones PW
        Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse.
        Br J Obstet Gynaecol. 1999; 106: 544-549
        • Combs Ca
        • Murphy EL
        • Laros Jr, RK
        Factors associated with postpartum hemorrhage with vaginal birth.
        Obstet Gynecol. 1991; 77: 69-76
        • Chadwick LM
        • Pemberton PJ
        • Kurinczuk JJ
        Neonatal subgaleal haematoma: associated risk factors, complications and outcome.
        J Paediatr Child Health. 1996; 32: 228-232
        • Perrin RG
        • Rutka JT
        • Drake JM
        • Meltzer H
        • Hellman J
        • Jay V
        • et al.
        Management and outcomes of posterior fossa subdural hematomas in neonates.
        Neurosurgery. 1997; 40: 1190-1200
        • Friedman EA
        • Sachtleben-Murray MR
        • Dahrouge D
        • Neff RK
        Long-term effects of labor and delivery on offspring: a matched-pair analysis.
        Am J Obstet Gynecol. 1984; 150: 941-945
        • Gordon M
        • Rich H
        • Deutschberger J
        • Green M
        The immediate and long-term outcome of obstetric birth trauma; I: brachial plexus paralysis.
        Am J Obstet Gynecol. 1973; 117: 51-56
        • Lydon-Rochelle M
        • Holt VL
        • Martin DP
        • Easterling TR
        Association between method of delivery and maternal rehospitalization.
        JAMA. 2000; 283: 2411-2416