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. (Am J Obstet Gynecol 1997;176:200-4.)


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