Severe Neonatal Morbidity in Forceps versus Vacuum Birth among Individuals with Previous Cesarean Birth: A Population-Based Retrospective Cohort Study

Irina I. Oltean; Abirami Kirubarajan; Vanessa Hébert; Elizabeth K. Darling; Rohan D'Souza; Giulia M. Muraca

doi:10.1055/a-2682-6209

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2682-6209

Original Article

Severe Neonatal Morbidity in Forceps versus Vacuum Birth among Individuals with Previous Cesarean Birth: A Population-Based Retrospective Cohort Study

Authors

Irina I. Oltean

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Abirami Kirubarajan

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada

²Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Vanessa Hébert

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Elizabeth K. Darling

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada

³Department of Obstetrics and Gynecology, McMaster Midwifery Research Centre, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Rohan D'Souza

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada

²Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
Giulia M. Muraca

¹Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada

²Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Canada

⁴Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden

Abstract

Objective

We sought to compare severe neonatal morbidity associated with forceps versus vacuum birth among individuals with prior cesarean birth.

Study Design

We conducted a population-based retrospective cohort study using data on all full term, singleton, cephalic vaginal births among individuals with prior cesarean birth in the United States (2014–2021). The exposure was operative vaginal birth (forceps vs. vacuum) and the primary outcome was composite severe neonatal morbidity, defined as assisted ventilation > 6 hours, neonatal seizures, and Apgar score < 4 at 5 minutes. We primarily compared the distribution of severe neonatal morbidity among operative vaginal births by instrument (forceps compared with vacuum) and fit multivariable logistic regression models to obtain adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for severe neonatal morbidity in forceps versus vacuum births while accounting for confounders.

Results

The study population included 531,440 births. The rate of severe neonatal morbidity was 0.7% with spontaneous vaginal birth, 1.6% with forceps, and 1.3% with vacuum. Adjusted models showed higher rates of severe neonatal morbidity with forceps versus vacuum birth, but this association was not statistically significant (AOR: 1.20, 95% CI: 0.96, 1.50). Analysis of each component of the severe neonatal morbidity composite showed a 39% higher odds of assisted ventilation > 6 hours (AOR: 1.39, 95% CI: 1.07, 1.80) in forceps compared with vacuum births.

Conclusion

Rates of severe neonatal morbidity are higher following operative versus spontaneous vaginal births with no difference based on type of instrument (forceps or vacuum). The choice between instrument should depend on the clinical situation, patient preference, and the experience, skill, and comfort of the operator.

Key Points

Rates of severe neonatal morbidity are higher following operative versus spontaneous vaginal births.
No difference in severe neonatal morbidity exists based on type of instrument (forceps or vacuum).
The choice between instrument should depend on the clinical situation and patient preference.

Keywords

pregnancy - infant - newborn - vacuum extraction - obstetrical - obstetrical forceps - birth - obstetric - obstetrical surgical instruments - morbidity

Full Text

References

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Supplementary Material

Supplementary Material (PDF)