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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