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The Cochrane Database of Systematic... Aug 2017Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to... (Review)
Review
BACKGROUND
Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.
OBJECTIVES
To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach.
MAIN RESULTS
One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay.
AUTHORS' CONCLUSIONS
One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
Topics: Antibiotic Prophylaxis; Endometritis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Puerperal Infection; Randomized Controlled Trials as Topic; Vacuum Extraction, Obstetrical; Vaginal Diseases
PubMed: 28779515
DOI: 10.1002/14651858.CD004455.pub4 -
Obstetrics and Gynecology Jun 2023To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births.
OBJECTIVE
To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births.
METHODS
This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders.
RESULTS
Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93-0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64-0.91).
CONCLUSION
In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Vacuum Extraction, Obstetrical; Retrospective Studies; Delivery, Obstetric; Cesarean Section; Dystocia; Obstetrical Forceps
PubMed: 37141591
DOI: 10.1097/AOG.0000000000005181 -
Fetal Diagnosis and Therapy 2010Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of... (Review)
Review
Ultrasound may play an important role in the management of labor and delivery. Induction of labor is a common obstetric intervention, performed in about 20% of pregnancies. Pre-induction cervical length, measured by transvaginal sonography, has been shown to have a significant association with the induction-to-delivery interval and the risk for cesarean section. In the management of labor there is extensive evidence that digital pelvic examination does not provide accurate assessment of the position and descend of the fetal head both during the first but also in the second stage of labor. Several recent studies using both two- and three-dimensional ultrasound have now described objective measures of progression of the fetal head during labor. In instrumental deliveries an important determinant of a successful and safe use of vacuum and forceps is the correct determination of the fetal head position and appropriate application of the instrument. However, ultrasound studies have shown that digital examination before instrumental delivery fails to identify the correct fetal position in a high proportion of cases. The use of ultrasound is of crucial importance in performing a safe operative delivery and can help in the prediction of whether a vaginal delivery would be successful.
Topics: Cervix Uteri; Delivery, Obstetric; Female; Humans; Labor Presentation; Labor, Induced; Labor, Obstetric; Obstetrical Forceps; Pregnancy; Pregnancy, Prolonged; Ultrasonography; Vacuum Extraction, Obstetrical
PubMed: 20173318
DOI: 10.1159/000287588 -
American Family Physician Oct 2020
Review
Topics: Adult; Antibiotic Prophylaxis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Prenatal Care; Puerperal Disorders; Randomized Controlled Trials as Topic; Surgical Wound Infection; Vacuum Extraction, Obstetrical
PubMed: 32996760
DOI: No ID Found -
British Medical Journal Jan 1965
Topics: Delivery, Obstetric; Female; Humans; Obstetrical Forceps; Pregnancy
PubMed: 14218473
DOI: 10.1136/bmj.1.5427.128 -
Women's Health (London, England) May 2008After centuries of use in obstetrics, have forceps and vacuum deliveries become a dying art? Contemporary trends in operative vaginal delivery show increasing numbers of... (Review)
Review
After centuries of use in obstetrics, have forceps and vacuum deliveries become a dying art? Contemporary trends in operative vaginal delivery show increasing numbers of vacuum deliveries and decreasing numbers of forceps deliveries worldwide. Primary drivers of such trends include concerns over neonatal and maternal safety as well as fewer clinicians skilled in forcep use. Current literature reports a comparable efficacy rate for the two instruments, as well as a decrease in maternal morbidity compared with cesarean section. It has also been suggested that the neonatal morbidity once associated with operative vaginal delivery may actually be a function of an abnormal labor process itself, rather than a consequence of an operative vaginal intervention. Both the American College and the Royal College of Obstetricians and Gynecologists continue to support the use of both vacuum and forceps and strongly encourage residency programs to incorporate the teaching of these skills into their curricula.
Topics: Birth Injuries; Delivery, Obstetric; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Obstetrical Forceps; Practice Guidelines as Topic; Pregnancy; Pregnancy Outcome; Societies, Medical; Vacuum Extraction, Obstetrical
PubMed: 19072477
DOI: 10.2217/17455057.4.3.281 -
Journal of Obstetrics and Gynaecology... Mar 2019This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second...
OBJECTIVE
This study sought to quantify perinatal and maternal morbidity and mortality associated with forceps and vacuum delivery compared with Caesarean delivery in the second stage of labour and to estimate whether these associations differed by pelvic station.
METHODS
The investigators conducted a population-based, retrospective cohort study of term singleton deliveries by operative delivery with prolonged second stage of labour in Canada (2003-2013) using national hospitalization data. The primary study outcomes were severe perinatal morbidity and mortality (i.e., seizures, assisted ventilation, severe birth trauma, and perinatal death) and severe maternal morbidity and mortality (i.e., severe postpartum hemorrhage, cardiac complication, and maternal death). Logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) after stratifying by indication (dystocia or fetal distress). The Breslow-Day chi-square test for heterogeneity in ORs was used to test effect modification by pelvic station (outlet, low, or midpelvic).
RESULTS
There were 61 106 deliveries included in the study. Among women with dystocia, forceps and vacuum deliveries were associated with higher rates of perinatal morbidity and mortality compared with Caesarean delivery (forceps: aOR 1.56; 95% CI 1.13-2.17; vacuum: aOR 1.44; 95% CI 1.06-1.97). Vacuum delivery was associated with lower rates of maternal morbidity and mortality compared with Caesarean delivery (dystocia: aOR 0.64; 95% CI 0.51-0.81; fetal distress: aOR 0.43; 95% CI 0.32-0.57). Pelvic station did not significantly modify the associations between forceps or vacuum and perinatal or maternal morbidity and mortality.
CONCLUSION
Forceps and vacuum delivery is associated with increased rates of severe perinatal morbidity and mortality compared with Caesarean delivery among women with dystocia, whereas vacuum delivery is associated with decreased rates of severe maternal morbidity and mortality.
Topics: Adult; Birth Injuries; Cesarean Section; Dystocia; Female; Fetal Distress; Gestational Age; Humans; Labor Stage, Second; Obstetric Labor Complications; Obstetrical Forceps; Pregnancy; Retrospective Studies; Vacuum Extraction, Obstetrical; Young Adult
PubMed: 30366887
DOI: 10.1016/j.jogc.2018.06.018 -
British Medical Journal Feb 1979
Topics: Birth Injuries; Delivery, Obstetric; Female; Humans; Infant, Newborn; Obstetrical Forceps; Pregnancy
PubMed: 761013
DOI: No ID Found -
Acta Obstetricia Et Gynecologica... Apr 2015Cesarean section rates have become a political issue, attracting the attention of governments, health bureaucrats and professional organizations. In some instances this...
Cesarean section rates have become a political issue, attracting the attention of governments, health bureaucrats and professional organizations. In some instances this has led to a renewed interest in forceps delivery, even Kielland's rotational forceps. It is suggested that calls for a greater use of forceps, especially rotational forceps, are ill-advised and commonly based on ignorance of recent urogynecological and imaging literature. Forceps use is associated with a much higher likelihood of major maternal trauma, especially to the anal sphincter and levator ani muscles, which may result in substantial future morbidity. Hence, its use should be avoided whenever possible. This is particularly obvious for rotational forceps.
Topics: Anal Canal; Birth Injuries; Cesarean Section; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Obstetrical Forceps; Pelvic Floor; Pregnancy
PubMed: 25625336
DOI: 10.1111/aogs.12592 -
The Cochrane Database of Systematic... Nov 2010Proponents of vacuum delivery argue that it should be chosen first for assisted vaginal delivery, because it is less likely to injure the mother. (Review)
Review
BACKGROUND
Proponents of vacuum delivery argue that it should be chosen first for assisted vaginal delivery, because it is less likely to injure the mother.
OBJECTIVES
The objective of this review was to assess the effects of vacuum extraction compared to forceps, on failure to achieve delivery and maternal and neonatal morbidity.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: February 1999.
SELECTION CRITERIA
Acceptably controlled comparisons of vacuum extraction and forceps delivery.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
MAIN RESULTS
Ten trials were included. The trials were of reasonable quality. Use of the vacuum extractor for assisted vaginal delivery when compared to forceps delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument.
AUTHORS' CONCLUSIONS
Use of the vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal haemorrhages seen with forceps may be a compensatory benefit.
Topics: Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Vacuum Extraction, Obstetrical
PubMed: 21069665
DOI: 10.1002/14651858.CD000224.pub2