Neonatal Outcomes and Operative Vaginal Delivery Versus Cesarean Delivery

ABSTRACT

We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at ≥36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (p = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (p = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.

KEYWORDS

Cesarean - forceps - umbilical cord blood gases - vacuum

REFERENCES

• 1 Menacker F. National Center for Health Statistics . Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990–2003.  Natl Vital Stat Rep. 2005;  54 1-8
• 2 Martin J A, Hamilton B E, Sutton P D National Center for Health Statistics et al. Births: Final data for 2005. Vol. 56, No. 6. Hyattsville, MD; National vital statistics reports 2007
• 3 Hannah M E, Hannah W J, Hewson S A, Hodnett E D, Saigal S, Willan A R. Term Breech Trial Collaborative Group . Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial.  Lancet. 2000;  356 1375-1383
• 4 Centers for Disease Control and Prevention .National Center for Health Statistics. VitalStats. Available at: http://www.cdc.gov/nchs/vitalstats.htm Accessed April 14, 2009
• 5 O'Leary C M, de Klerk N, Keogh J et al.. Trends in mode of delivery during 1984-2003: can they be explained by pregnancy and delivery complications?.  BJOG. 2007;  114 855-864
• 6 Haupt B J. National Center for Health Statistics .Deliveries in short-stay hospitals. Advance Data from Vital and Health Statistics, No. 83, DHHS Pub. No. (PHS) 82–1250. Hyattsville, MD; Public Health Service October 8, 1982
• 7 Martin J A, Hamilton B E, Sutton P D et al.. Births: Final data for 2004. National vital statistics reports; Vol. 55, No. 1. Hyattsville, MD; National Center for Health Statistics 2006
• 8 Cheong Y C, Abdullahi H, Lashen H, Fairlie F M. Can formal education and training improve the outcome of instrumental delivery?.  Eur J Obstet Gynecol Reprod Biol. 2004;  113 139-144
• 9 Learman L A. Regional differences in operative obstetrics: a look to the South.  Obstet Gynecol. 1998;  92(4 Pt 1) 514-519
• 10 Towner D R, Ciotti M C. Operative vaginal delivery: a cause of birth injury or is it?.  Clin Obstet Gynecol. 2007;  50 563-581
• 11 Murphy D J, Pope C, Frost J, Liebling R E. Women's views on the impact of operative delivery in the second stage of labour: qualitative interview study.  BMJ. 2003;  327 1132
• 12 Wen S W, Liu S, Kramer M S et al.. Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.  Am J Epidemiol. 2001;  153 103-107
• 13 Demissie K, Rhoads G G, Smulian J C et al.. Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.  BMJ. 2004;  329 24-29
• 14 Towner D, Castro M A, Eby-Wilkens E, Gilbert W M. Effect of mode of delivery in nulliparous women on neonatal intracranial injury.  N Engl J Med. 1999;  341 1709-1714
• 15 Milsom I, Ladfors L, Thiringer K, Niklasson A, Odeback A, Thornberg E. Influence of maternal, obstetric and fetal risk factors on the prevalence of birth asphyxia at term in a Swedish urban population.  Acta Obstet Gynecol Scand. 2002;  81 909-917
• 16 American College of Obstetricians and Gynecologists .Clinical management guidelines for obstetrician gynecologists: Operative vaginal delivery. Washington, DC; Practice Bulletin No. 17 June 2000
• 17 Bloom S L, Spong C Y, Thom E National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network et al. Fetal pulse oximetry and cesarean delivery.  N Engl J Med. 2006;  355 2195-2202
• 18 Goldaber K G, Gilstrap III L C, Leveno K J, Dax J S, McIntire D D. Pathologic fetal acidemia.  Obstet Gynecol. 1991;  78 1103-1107
• 19 Helwig J T, Parer J T, Kilpatrick S J, Laros Jr R K. Umbilical cord blood acid-base state: what is normal?.  Am J Obstet Gynecol. 1996;  174 1807-1812 discussion 1812-1814
• 20 American College of Obstetricians and Gynecologists and American Academy of Pediatrics .Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology. Washington, DC; American College of Obstetricians and Gynecologists 2003
• 21 Nelson K B, Chang T. Is cerebral palsy preventable?.  Curr Opin Neurol. 2008;  21 129-135
• 22 Gilstrap III L C, Leveno K J, Burris J, Williams M L, Little B B. Diagnosis of birth asphyxia on the basis of fetal pH, Apgar score, and newborn cerebral dysfunction.  Am J Obstet Gynecol. 1989;  161 825-830
• 23 Alexander J M, Leveno K J, Rouse D J National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU) et al. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor.  Obstet Gynecol. 2007;  109 917-921
• 24 Johnson J H, Figueroa R, Garry D, Elimian A, Maulik D. Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries.  Obstet Gynecol. 2004;  103 513-518
• 25 Graham E M, Ruis K A, Hartman A L, Northington F J, Fox H E. A systematic review of the role of intrapartum hypoxia-ischemia in the causation of neonatal encephalopathy.  Am J Obstet Gynecol. 2008;  199 587-595
• 26 Larma J D, Silva A M, Holcroft C J et al.. Intrapartum electronic fetal heart rate monitoring and the identification of metabolic acidosis and hypoxic–ischemic encephalopathy.  Am J Obstet Gynecol. 2007;  197 301.e1-301.e8
• 27 Menticoglou S M, Manning F, Harman C, Morrison I. Perinatal outcome in relation to second-stage duration.  Am J Obstet Gynecol. 1995;  173(3 Pt 1) 906-912