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To determine whether the duration of operative vaginal delivery (OVD) is associated with adverse maternal and neonatal outcomes.
This is a secondary analysis of a multi-center prospective observational study of women who delivered at 25 hospitals over a 3-year period. Women who underwent an attempted low or outlet OVD with a single instrument type (i.e., vacuum or forceps) were included in analysis. Women were stratified by the duration of OVD (minutes from vacuum or forceps application to delivery) and the number of pop offs (vacuum) or pulls attempted (forceps). Severe (3rd or 4th degree) perineal lacerations, failed OVD, and a composite adverse neonatal outcome (brachial plexus injury, facial nerve palsy, clavicular fracture, skull fracture, other skeletal fracture, skin laceration, intracranial hemorrhage, seizure that required treatment, or neonatal death) were compared by the duration of OVD and number of pop offs or pulls. Multivariable logistic regression analyses were performed to adjust for confounders.
Of the 5325 women who had an attempted OVD, 3594 (67.5%) were with vacuum and 1731 (32.5%) were with forceps. 292 (5.5%) of the OVD attempts (5.8% of vacuums vs. 4.9% of forceps, p = 0.20) failed and required cesarean delivery. The results of multivariable analyses are presented in the Table. An increasing number of vacuum pop offs, but not number of forceps pulls or duration of OVD (for either vacuum or forceps), was associated with an increased risk of severe perineal lacerations. An increasing number of pop offs and forceps pulls, but not OVD duration generally was associated with an increased risk of failed OVD. Conversely, it was the duration of OVD that was most consistently associated with adverse neonatal outcomes.
The duration of OVD, rather than number of pop-offs or pulls, is more consistently associated with adverse neonatal outcomes.