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Am J Perinatol 2017; 34(10): 0974-0981
DOI: 10.1055/s-0037-1601441
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Influence of Patient-Level Factors on Mode of Delivery among Operative Vaginal Delivery Candidates in Modern Practice

Authors

  • Torri D. Metz

    1   University of Colorado, School of Medicine, Aurora, Colorado
    2   Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado

  • Christina Gonzalez

    1   University of Colorado, School of Medicine, Aurora, Colorado

  • Amanda A. Allshouse

    3   Department of Biostatistics and Informatics, Colorado School of Public Health at the University of Colorado Denver, Denver, Colorado

  • Erick Henry

    4   Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah

  • Sean Esplin

    5   Intermountain Healthcare, Salt Lake City, Utah
Further Information

Publication History

04 January 2017

01 March 2017

Publication Date:
04 April 2017 (online)

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Abstract

Objective We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery.

Study Design Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital.

Results Total 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76–2.65), nulliparity (OR = 2.06, 95% CI: 1.59–2.66), epidural (OR = 2.05, 95% CI: 1.19–3.56), maternal indication (OR = 1.53, 95% CI 1.16–2.02), older maternal age (OR 1.18, 95% CI 1.06–1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01–1.20 per hour).

Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23–11.20), a perinatologist (OR = 2.51, 95% CI: 1.09–5.78), longer second stage (OR = 1.79, 95% CI: 1.65–1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01–1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01–1.04 per hour).

Conclusion Patient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.

Keywords

clinical characteristics - forceps - indication - operative delivery - vacuum

Note

Abstract presented as a poster presentation at the 62nd American College of Obstetricians and Gynecologists Annual Meeting, Chicago, IL, April 26–30, 2014.