Document Detail

Forceps compared with vacuum: rates of neonatal and maternal morbidity.
MedLine Citation:
PMID:  16260505     Owner:  NLM     Status:  MEDLINE    
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. LEVEL OF EVIDENCE: II-2.
Aaron B Caughey; Per L Sandberg; Marya G Zlatnik; Mari-Paule Thiet; Julian T Parer; Russell K Laros
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  106     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-01     Completed Date:  2006-02-07     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  908-12     Citation Subset:  AIM; IM    
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, 505 Parnassus Avenue, Box 132, San Francisco, CA 94143, USA.
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MeSH Terms
Birth Injuries / etiology*
Cohort Studies
Infant, Newborn
Lacerations / etiology*
Obstetrical Forceps*
Perineum / injuries*
Retrospective Studies
Shoulder Dislocation / etiology*
Term Birth
Vacuum Extraction, Obstetrical / adverse effects*,  instrumentation
Grant Support
Comment In:
Obstet Gynecol. 2006 Feb;107(2 Pt 1):426-7; author reply 427   [PMID:  16449136 ]
Obstet Gynecol. 2006 Mar;107(3):739-40; author reply 740   [PMID:  16507949 ]

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