Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 126; no. 6; pp. 1265 - 1272
• Main Authors: Halscott, Torre L., Reddy, Uma M., Landy, Helain J., Ramsey, Patrick S., Iqbal, Sara N., Huang, Chun-Chih, Grantz, Katherine L.
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01-12-2015
• Subjects: Adult; Cesarean Section - adverse effects; Extraction, Obstetrical - adverse effects; Extraction, Obstetrical - methods; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Newborn, Diseases - etiology; Labor Stage, Second; Logistic Models; Obstetric Labor Complications - epidemiology; Obstetric Labor Complications - etiology; Odds Ratio; Pregnancy; Retrospective Studies
• DOI: 10.1097/AOG.0000000000001156
• EISSN: 1873-233X
• ISSN: 0029-7844

OBJECTIVE:To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor.
METHODS:Retrospective study of 2,518 women carrying singleton fetuses at 37 weeks of gestation or greater who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit admission) and a neonatal adverse outcome composite (5-minute Apgar score less than 4, respiratory morbidity, neonatal intensive care unit admission, shoulder dystocia, birth trauma, or sepsis).
RESULTS:In nulliparous patients, the maternal adverse composite was not significantly different between women who underwent attempted forceps (12.1% compared with 10.8%, adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.40–1.34) or vacuum (8.3% compared with 10.8%, adjusted OR 0.68, 95% CI 0.40–1.16) delivery compared with cesarean delivery. Among parous women, the maternal adverse composite was not significantly different with attempted forceps (10.7% compared with 12.5%, adjusted OR 0.40, 95% CI 0.09–1.71) or vacuum (11.3% compared with 12.5%, adjusted OR 0.44, 95% CI 0.11–1.72) compared with cesarean delivery. Compared with neonates delivered by cesarean, the neonatal adverse composite was significantly lower among neonates born to nulliparous women who underwent attempted forceps (9.4% compared with 16.7%, adjusted OR 0.44, 95% CI 0.27–0.72) but not among those who underwent vacuum delivery (11.9% compared with 16.7%, adjusted OR 0.68, 95% CI 0.44–1.04). Among parous women, the neonatal adverse composite was not significantly different after attempted forceps (4.1% compared with 12.5%, adjusted OR 0.28, 95% CI 0.06–1.35) or vacuum (12.5% compared with 12.5%, adjusted OR 1.03, 95% CI 0.28–3.87) compared with cesarean delivery.
CONCLUSION:A trial of forceps delivery from a low station compared with cesarean delivery was associated with decreased neonatal morbidity among neonates born to nulliparous women.
LEVEL OF EVIDENCE:II