Emily S Miller1, Yinglei Lai2, Jennifer Bailit3, Uma M Reddy, Ronald J Wapner4, Michael W Varner5, John M Thorp6, Kenneth J Leveno7, Steve N Caritis8, Mona Prasad9, Alan T N Tita10, George R Saade11, Yoram Sorokin12, Dwight J Rouse13, Sean C Blackwell14, Jorge E Tolosa15. 1. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois. 2. Biostatistics Center, The George Washington University, Washington, District of Columbia. 3. Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio. 4. Department of Obstetrics and Gynecology, Columbia University, New York, New York. 5. Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah. 6. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 7. Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas. 8. Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. 10. Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. 11. Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas. 12. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 13. Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island. 14. Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas. 15. Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
Abstract
OBJECTIVE: This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes. STUDY DESIGN: This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls. RESULTS: Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application. CONCLUSION: The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes. STUDY DESIGN: This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls. RESULTS: Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application. CONCLUSION: The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: William A Grobman; Jennifer L Bailit; Madeline Murguia Rice; Ronald J Wapner; Michael W Varner; John M Thorp; Kenneth J Leveno; Steve N Caritis; Jay D Iams; Alan T Tita; George Saade; Yoram Sorokin; Dwight J Rouse; Jorge E Tolosa; J Peter Van Dorsten Journal: Am J Obstet Gynecol Date: 2014-03-12 Impact factor: 8.661
Authors: Jennifer L Bailit; William A Grobman; Madeline Murguia Rice; Catherine Y Spong; Ronald J Wapner; Michael W Varner; John M Thorp; Kenneth J Leveno; Steve N Caritis; Phillip J Shubert; Alan T Tita; George Saade; Yoram Sorokin; Dwight J Rouse; Sean C Blackwell; Jorge E Tolosa; J Peter Van Dorsten Journal: Am J Obstet Gynecol Date: 2013-07-24 Impact factor: 8.661