Am J Perinatol 2020; 37(05): 503-510
DOI: 10.1055/s-0039-1683439
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Emily S. Miller
1  Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Yinglei Lai
2  Biostatistics Center, The George Washington University, Washington, District of Columbia
,
Jennifer Bailit
3  Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Uma M. Reddy
4  Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
5  Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner
6  Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
,
John M. Thorp Jr.
7  Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Kenneth J. Leveno
8  Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
,
Steve N. Caritis
9  Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Mona Prasad
10  Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Alan T. N. Tita
11  Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
George R. Saade
12  Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
13  Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Dwight J. Rouse
14  Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
,
Sean C. Blackwell
15  Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Jorge E. Tolosa
16  Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network*
› Author Affiliations
Funding The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD21410, HD27869, HD27915, HD27917, HD34116, HD34208, HD36801, HD40500, HD40512, HD40544, HD40545, HD40560, HD40485, HD53097, HD53118) and the National Center for Research Resources (UL1 RR024989; 5UL1 RR025764). Comments and views of the authors do not necessarily represent views of the NIH.
Further Information

Publication History

23 October 2018

05 February 2019

Publication Date:
20 March 2019 (online)

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.

Note

These findings were presented at the Society for Maternal-Fetal Medicine annual meeting in Atlanta, GA, 2016.


* See [Supplementary Material] (available in the online version) for a list of other members of the NICHD MFMU Network.


Supplementary Material