647: Neonatal morbidity and mortality of operative vaginal delivery: a 10-year study of 82,000 infants

Abstract

vaginal delivery: a 10-year study of 82,000 infants Colin Walsh, Michael Robson, Fionnuala McAuliffe National Maternity Hospital, Maternal-Fetal Medicine, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dublin, Ireland, UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: To examine the relationship between operative vaginal delivery and early neonatal mortality and morbidity, in a single tertiary maternity unit over a 10-year period. STUDY DESIGN: This is a retrospective analysis of hospital clinical records for the period 2000-2009. All cases of intrapartum fetal and early neonatal ( 7 days) death, and neonatal encephalopathy (NE) occurring in our institution were evaluated. The primary outcome was fetal/ neonatal death secondary to traumatic intracranial hemorrhage (TICH). Secondary outcomes were total peripartum (intrapartum and early neonatal) deaths and rates of NE. RESULTS: Between 2000 and 2009, 82,327 infants 500g were delivered. The overall rate of Cesarean birth was 17% during the study period. Thus, 69,094 infants delivered vaginally, of which 16% (n 10,913) had an operative vaginal delivery (Table 1). We found no difference in the incidence of neonatal complications in forcepsversus vacuum-assisted births (p 0.05 for all outcome measures). The incidence of TICH in infants born by operative vaginal birth (0.27 per 1,000) was not different from those born by Cesarean birth (p 0.20) but was higher than for infants born by spontaneous vaginal birth (p 0.02 Table 1). Infants born by operative vaginal birth had a similar rate of peripartum death (p 0.30), but a higher rate of neonatal encephalopathy (p 0.0001), compared to those born by spontaneous vaginal birth. We found no difference in the incidence of NE in infants born by operative vaginal birth compared to those born by Cesarean birth(p 0.12). CONCLUSION: The incidence of peripartum neonatal death from TICH is low (approximately 3 per 10,000 operative vaginal deliveries) for both forcepsand vacuum-assisted births. Rates of both TICH-related death and total peripartum deaths are similar for both instruments. Although rates of NE were higher in operative versus spontaneous vaginal births, this was mostly related to the indication for delivery rather than the mode of delivery. This is substantiated by a finding of similar rates of NE in operative vaginal and Cesarean births.