Forceps compared with vacuum: Rates of neonatal and maternal morbidity

Aaron Caughey, Per L. Sandberg, Marya G. Zlatnik, Mari Paule Thiet, Julian T. Parer, Russell K. Laros

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

OBJECTIVE: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations. METHODS: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression. RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5% compared with 3.5%, P <.001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P <.001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9% compared with 26.8%, P <.001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95% confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95% CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95% CI 1.52-2.10) when comparing forceps to vacuum. CONCLUSION: Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.

Original languageEnglish (US)
Pages (from-to)908-912
Number of pages5
JournalObstetrics and Gynecology
Volume106
Issue number5 I
StatePublished - Nov 2005
Externally publishedYes

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Vacuum
Surgical Instruments
Lacerations
Dystocia
Mothers
Morbidity
Confidence Intervals
Episiotomy
Maternal Age
Parity
Cohort Studies
Anesthesia
Retrospective Studies
Logistic Models
Odds Ratio
Head
Parturition
Physicians
Wounds and Injuries

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Caughey, A., Sandberg, P. L., Zlatnik, M. G., Thiet, M. P., Parer, J. T., & Laros, R. K. (2005). Forceps compared with vacuum: Rates of neonatal and maternal morbidity. Obstetrics and Gynecology, 106(5 I), 908-912.

Forceps compared with vacuum : Rates of neonatal and maternal morbidity. / Caughey, Aaron; Sandberg, Per L.; Zlatnik, Marya G.; Thiet, Mari Paule; Parer, Julian T.; Laros, Russell K.

In: Obstetrics and Gynecology, Vol. 106, No. 5 I, 11.2005, p. 908-912.

Research output: Contribution to journalArticle

Caughey, A, Sandberg, PL, Zlatnik, MG, Thiet, MP, Parer, JT & Laros, RK 2005, 'Forceps compared with vacuum: Rates of neonatal and maternal morbidity', Obstetrics and Gynecology, vol. 106, no. 5 I, pp. 908-912.
Caughey A, Sandberg PL, Zlatnik MG, Thiet MP, Parer JT, Laros RK. Forceps compared with vacuum: Rates of neonatal and maternal morbidity. Obstetrics and Gynecology. 2005 Nov;106(5 I):908-912.
Caughey, Aaron ; Sandberg, Per L. ; Zlatnik, Marya G. ; Thiet, Mari Paule ; Parer, Julian T. ; Laros, Russell K. / Forceps compared with vacuum : Rates of neonatal and maternal morbidity. In: Obstetrics and Gynecology. 2005 ; Vol. 106, No. 5 I. pp. 908-912.
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abstract = "OBJECTIVE: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations. METHODS: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression. RESULTS: Among the 2,075 (50.4{\%}) forceps- and 2,045 (49.6{\%}) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5{\%} compared with 3.5{\%}, P <.001), as was the rate of cephalohematoma (4.5{\%} compared with 14.8{\%}, P <.001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9{\%} compared with 26.8{\%}, P <.001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95{\%} confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95{\%} CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95{\%} CI 1.52-2.10) when comparing forceps to vacuum. CONCLUSION: Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.",
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T2 - Rates of neonatal and maternal morbidity

AU - Caughey, Aaron

AU - Sandberg, Per L.

AU - Zlatnik, Marya G.

AU - Thiet, Mari Paule

AU - Parer, Julian T.

AU - Laros, Russell K.

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N2 - OBJECTIVE: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations. METHODS: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression. RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5% compared with 3.5%, P <.001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P <.001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9% compared with 26.8%, P <.001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95% confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95% CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95% CI 1.52-2.10) when comparing forceps to vacuum. CONCLUSION: Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.

AB - OBJECTIVE: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations. METHODS: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression. RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5% compared with 3.5%, P <.001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P <.001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9% compared with 26.8%, P <.001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95% confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95% CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95% CI 1.52-2.10) when comparing forceps to vacuum. CONCLUSION: Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.

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