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Grand Rounds

Are Number of Pop-Offs, Forcep Pulls or Longer Operative Vaginal Delivery Times Associated with Adverse Neonatal Outcomes?

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BACKGROUND AND PURPOSE:

  • Miller et al. (American Journal of Perinatology, 2019) examined whether the number of vacuum pop-offs, forceps pulls, or duration of attempted operative vaginal delivery was associated with adverse fetal or maternal outcomes

METHODS:

  • Secondary analysis of a multicenter observational cohort study
    • NICHD MFMU abstracted data between 2008-2011
    • Pregnancies >23 weeks
    • 115,502 women | 25 hospitals
  • Participants
    • Women who underwent OVD
  • Women were stratified by
    • Duration of OVD (0-2, 3-5, 6-8, 9-11, ≥12 minutes)
    • Number of vacuum pop-offs or forceps pulls (0, 1, 2, ≥3)
  • Primary outcomes
    • Severe perineal lacerations
    • Failed OVD
    • Composite adverse neonatal outcome

RESULTS:

  • 5,325 women underwent an attempt at OVD
    • Vacuum: 67.5% | Forceps: 32.5%
  • Median duration
    • Vacuum: 4 minutes (interquartile range: 2–7 minutes)
    • Forceps: 4 minutes (interquartile range: 2–6 minutes)
  • Attempted vacuum
    • Number of pop-offs and duration of procedure both associated with
      • Failed OVD | Severe perineal lacerations | Adverse neonatal outcomes
    • However, duration was more strongly correlated with adverse outcome than number of pop-offs
  • Attempted forceps
    • Number of pulls
      • Associated with: Failed OVD | Severe perineal lacerations
      • Not associated with: Composite neonatal adverse outcome
    • Duration of forceps
      • Associated with: Failed OVD | Severe perineal lacerations | Adverse neonatal outcomes
  • Increasing minutes of OVD was associated with composite adverse neonatal outcomes
    • Vacuum: Adjusted odds ratio [aOR] 1.09 (95% CI, 1.03–1.16)
    • Forceps: aOR 1.13 (95% CI, 1.03–1.24)
    • No association with fetal station or indication

CONCLUSION:

  • While an increased number of vacuum pop-offs or forceps pulls may be associated with adverse neonatal outcomes, duration of OVD attempt is more highly associated with adverse neonatal outcomes
  • Authors note that
    • This study evaluates association and not causation
    • Does not provide evidence that cesarean would result in better outcomes

Learn More – Primary Sources:

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

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Related ObG Topics:

Forceps/Vacuum Delivery vs Cesarean Section and Adverse Maternal and Perinatal Outcomes
ANODE RCT Results: Antibiotic Prophylaxis for Forceps or Vacuum Extraction?
Operative Vaginal Delivery or Repeat Cesarean Section During Trial of Labor

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