Neonatal Outcomes and Operative Vaginal Delivery Versus Cesarean Delivery

Stephen A Contag; Rebecca G Clifton; Steven L Bloom; Catherine Y Spong; Michael W Varner; Dwight J Rouse; Susan M Ramin; Steve N Caritis; Alan M Peaceman; Yoram Sorokin; Anthony Sciscione; Marshall W Carpenter; Brian M Mercer; John M Thorp; Fergal D Malone; Jay D Iams

doi:10.1055/s-0030-1247605

American Journal of Perinatology, Table of Contents

Am J Perinatol 2010; 27(6): 493-499
DOI: 10.1055/s-0030-1247605

Neonatal Outcomes and Operative Vaginal Delivery Versus Cesarean Delivery

Stephen A. Contag¹ , Rebecca G. Clifton² , Steven L. Bloom³ , Catherine Y. Spong⁴ , Michael W. Varner⁵ , Dwight J. Rouse⁶ , Susan M. Ramin⁷ , Steve N. Caritis⁸ , Alan M. Peaceman⁹ , Yoram Sorokin¹⁰ , Anthony Sciscione¹¹ , Marshall W. Carpenter¹² , Brian M. Mercer¹³ , John M. Thorp¹⁴ , Fergal D. Malone¹⁵ , Jay D. Iams¹⁶

¹Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, North Carolina
²George Washington University Biostatistics Center, Washington, D.C.
³University of Texas Southwestern Medical Center, Dallas, Texas
⁴Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
⁵University of Utah, Salt Lake City, Utah
⁶University of Alabama at Birmingham, Birmingham, Alabama
⁷University of Texas at Houston, Houston, Texas
⁸University of Pittsburgh, Pittsburgh, Pennsylvania
⁹Northwestern University, Chicago, Illinois
¹⁰Wayne State University, Detroit, Michigan
¹¹Drexel University, Philadelphia, Pennsylvania
¹²Brown University, Providence, Rhode Island
¹³Case Western Reserve University, Cleveland, Ohio
¹⁴University of North Carolina, Chapel Hill, North Carolina
¹⁵Columbia University, New York, New York
¹⁶The Ohio State University, Columbus, Ohio

Abstract

ABSTRACT

We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at ≥36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (p = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (p = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

KEYWORDS

Cesarean - forceps - umbilical cord blood gases - vacuum

Full Text

References

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Stephen A ContagM.D.

Institute for Maternal Fetal Medicine, Department of Obstetrics and Gynecology

Sinai Hospital, 2401 West Belvedere Ave, Baltimore, MD 21215; reprints are not available from the author

Email: scontag@lifebridgehealth.org