Neonatal and maternal outcome in low-pelvic and midpelvic operative deliveries

Article Abstract:

Vaginal operative deliveries involve the use of forceps or vacuum devices to help deliver the fetus. The increasing rate of cesarean deliveries and the increase in obstetrical lawsuits have inhibited the use of vaginal operative deliveries. The American College of Obstetrics and Gynecology has presented a new system of station, which is the position of the fetus's head in relation to the spines of the pelvis (at zero the skull is at the pelvic spines, at +5 the head is out and at -5 the head is floating up high in the pelvis) and has redefined the concept of outlet (low-pelvic and midpelvic). On the basis of these new definitions, the risks and benefits of operative vaginal deliveries were compared with the risks and benefits of cesarean deliveries having similarly-matched stations. Midoperative delivery was defined as a head station of above +2. Low operative delivery was defined as a head station of +2 or below. The four categories of vaginal delivery were midforceps, midvacuum, low-forceps and low-vacuum. Both the forceps- and vacuum-delivered groups had less maternal blood loss and decreased hospital stay and maternal complications as compared with the cesarean-delivered groups. In the midpelvic deliveries there was an increase in fetal resuscitation and an increase in the base deficit (a measurement of blood acidity which can be used to assess oxygen deprivation and fetal distress) in the umbilical artery. In the midforceps and low-forceps groups, there was a decrease in the pH of the cord arterial blood and an increase in the base deficit, even in the absence of fetal distress. An increased number of infants delivered by midforceps were admitted to the neonatal intensive care unit, and they had an increased risk of birth trauma. Therefore midforceps deliveries were associated with more injury to the fetus than the other methods. Midvacuum delivery was also associated with detrimental effects on the fetus. The midforceps and midvacuum deliveries involve more risk to the fetus, and less to the mother, than cesarean delivery; these risks must be weighed when choosing the delivery method. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Labor, Complicated, Labor complications

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Incidence of persistent birth injury in macrosomic infants: association with mode of delivery

Article Abstract:

It appears advisable to attempt careful vaginal deliveries with larger infants. The rates of short- and long-term injuries were compared among 2,924 infants weighing more than 4,000 grams (gm) and 16,711 infants weighing between 3,000 and 3,999 gm. Overall, 1.6% of the larger infant group sustained short-term injuries compared with only 0.35% of the lower weight group. However, only 0.3% of the injuries in the larger weight group were still evident at six months of age. Injuries were four times more likely among infants delivered with forceps compared to those delivered by cesarean or by a normal vaginal delivery.

Injuries, Complications and side effects, Fetus, Fetal macrosomia

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A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor

Article Abstract:

The M-cup vacuum extractor may deliver infants more quickly than forceps but may produce more injuries to the infant's head. Researchers delivered 315 infants by forceps and 322 by the M-cup vacuum extractor. Forceps deliveries caused fewer injuries to the infant head but more genital tears in the mother. M-cup deliveries produced more molding and swelling of the infant head but fewer maternal genital tears and a reduced need for episiotomy. M-cup deliveries were an average of one minute faster than forceps deliveries. Ninety-four percent of M-cup deliveries were successful.

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