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Grand Rounds

Forceps vs Vacuum: Impact on Maternal and Neonatal Outcomes

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BACKGROUND AND PURPOSE:

  • Froeliger et al. (Obstetrics & Gynecology, 2022) assessed severe short-term maternal and neonatal morbidity and pelvic floor disorders at 6 months postpartum after attempted operative vaginal delivery

METHODS:

  • Prospective study
  • Participants
    • Live, singleton, term fetuses
    • Vertex presentation
    • Attempted operative vaginal delivery
  • Exposures
    • Vacuum-assisted
    • Forceps- or spatula-assisted (two independent blades not connected to each other)
  • Study design
    • Multivariable logistic regression and propensity score methods used to control for indications and compare outcomes based on instrument
    • Secondary symptom outcomes assessed at 6 months postpartum | Validated self-administered questionnaires
  • Primary outcomes
    • Composite of severe maternal morbidity
    • Composite of severe neonatal morbidity
  • Secondary outcomes
    • Urinary incontinence (UI)
    • Anal incontinence (AI)

RESULTS:

  • 2,128 attempted operative vaginal deliveries
    • Vacuum-assisted: 30.7%
    • Forceps- or spatula-assisted: 69.3%
    • Responded to questionnaire at 6 months: 43.9%
  • Severe maternal morbidity occurred more often in forceps- or spatula-assisted deliveries (P<0.001)
    • Vacuum: 5.4% (95% CI, 3.8 to 7.4)
    • Forceps or spatula: 10.5% (95% CI, 8.3 to 12.1)
  • Attempted operative vaginal deliveries with forceps or spatula were associated with more frequent severe maternal morbidity
    • aOR 1.99 (95% CI, 1.27 to 3.10)
  • Association was no longer significant after propensity-score matching for indications
    • aOR 1.46 (95% CI, 0.72 to 2.95)
  • No significant difference in neonatal morbidity (P=0.2)
    • Vacuum: 8.4% (95% CI, 6.4 to 10.8)
    • Forceps or spatula: 10.2% (95% CI, 8.7 to 11.8)
    • Not effected propensity-score matching
  • Secondary outcome prevalence at 6 months
    • Urinary incontinence: 22.7%
    • Anal incontinence: 22.0%
    • No significant differences seen when comparing instruments

CONCLUSION:

  • There was no difference in severe maternal or neonatal morbidity based on vacuum vs forceps once adjustments were made for indication bias
  • There was also no difference in urinary or anal incontinence at 6 months follow up based on instrument type
  • The authors state

These results support the use of vacuum or forceps or spatulas, depending mainly on the operator’s preference

Learn More – Primary Sources:

Maternal and Neonatal Morbidity After Attempted Operative Vaginal Delivery

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Related ObG Topics:

Mode of Delivery and Risk of Pelvic Floor Disorders, Quantified Over Time
Forceps/Vacuum Delivery vs Cesarean Section and Adverse Maternal and Perinatal Outcomes
Are Number of Pop-Offs, Forcep Pulls or Longer Operative Vaginal Delivery Times Associated with Adverse Neonatal Outcomes?

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