Operative vaginal delivery in singleton term pregnancies: Short-term maternal and neonatal outcomes

Hippokratia 2009, 13(1):41-45

N. Prapas, I. Kalogiannidis, S. Masoura, E. Diamanti, A. Makedos, D. Drossou, G. Makedos


Background: The rate of operative vaginal delivery has remained stable the last decade, however the rate of vacuum has increased against forceps application. Different maternal and neonatal outcomes have been proposed by many reports. The aim of the present study is to compare the short term maternal and neonatal outcomes between vacuum and forceps delivery.Material and methods: We conducted a medical record review of live born singleton, vacuum and forceps-deliveries. Maternal and delivery characteristics were recorded. Maternal and neonatal outcomes were also assessed. Out of 7098 deliveries, 374 were instrument assisted, 324 were conducted by vacuum (86.7%) and 50 by forceps (13.3%). Results: The incidence of 3rd degree lacerations and periurethral hematomas was similar between vacuum and forceps (3.4% vs. 2% and 0.3% vs 0% respectively), while perineal hematomas were more common in forceps compared with vacuum application (2% vs 0.3% respectively), albeit not significantly. The rate of neonates with Apgar scores ≤ 4 at 1 min was significantly higher after forceps compared with vacuum delivery (18% vs 5.2% respectively, p = 0.0003). The same observation was made concerning the neonatal intensive care unit (NICU) admissions (38% vs 11% respectively, p = 0.0001). The rate of neonatal trauma and respiratory distress syndrome did not differ significantly between the two groups. Conclusion: Results of the present study indicate that both modes of instrumental vaginal delivery are safe with respect to maternal morbidity and neonatal trauma. However, forceps application increases the risk of neonatal compromise consequently necessitating their admission in the NICU.