Operative Vaginal Birth: Indications and Clinical Considerations
Operative birth delivery is an important component of modern obstetrics. Its purpose is to achieve or expedite a vaginal delivery. The rate of operative deliveries has significantly decreased in the last two decades, accounting for part of the increase in cesarean delivery rates in the United States.
Types of Instruments
Vacuum: believed to be easier to learn and may be used with asynclitism
Forceps: more secure application and appropriate for rotation
Prolonged second stage
Suspicion of immediate or potential fetal compromise
Shortening of the second stage of labor for maternal benefit
Fetal head unengaged
Position of the head is unknown
Known or strongly suspected fetal bone demineralization condition or bleeding disorder
Lack of experienced provider
Avoids cesarean birth and its associated complications
Hemorrhage | Infection | Prolonged healing time | Increased cost | Likelihood of repeat cesarean birth and associated placental abnormalities in subsequent pregnancies
Can be accomplished quicker than cesarean birth
Higher rates of anal sphincter injuries with operative vaginal birth compared to spontaneous vaginal birth
Forceps is more likely to achieve vaginal birth than vacuum but is more likely to be associated with third- and fourth- degree perineal tears
More common at 6 weeks postpartum but no difference by 1 year
If no anal laceration, rates are similar to spontaneous vaginal birth at 5 to 10 years after delivery
Sexual function scores and pelvic floor function
No difference at 1 year postpartum when compared to clinical alternative second stage cesarean birth
Absolute rate of newborn injury with operative vaginal birth is low
Some injuries are associated with the indication for delivery | Risk is not lessened by cesarean birth
Vacuum extraction is associated with higher risks for
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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