785: Antepartum risk factors and delivery-related morbidities in cases of failed operative vaginal deliveries

Abstract

784 Failure rate and delivery-related maternal morbidity in vacuum delivery, forceps delivery, or a combination of both Alex Fong, Erica Wu, Deyu Pan, Dotun Ogunyemi, Judith Chung University of California, Irvine, Obstetrics and Gynecology, Orange, CA, Charles Drew University of Medicine and Science, Research SLI, Los Angeles, CA, University of California, Los Angeles, Obstetrics and Gynecology, Los Angeles, CA OBJECTIVE: To assess the differences in delivery-related morbidity and failure rate when comparing vacuum delivery, forceps delivery, or combined use of both. STUDY DESIGN: We used 2001-2007 California discharge data to identify cases of forceps and vacuum delivery via ICD-9. After eliminating cases with incomplete data, we identified 202,439 cases of vacuum, 13,555 cases of forceps, and 710 cases where both were used. We used logistic regression to adjust for potential confounders. RESULTS: Morbidities increased in forceps compared to vacuum deliveries included third/fourth degree lacerations (OR 2.07, 95%CI 1.98-2.16), postpartum hemorrhage (OR 1.51, 95%CI 1.39-1.64), manual extraction of placenta (OR 1.35, 95%CI 1.17-1.55), pelvic hematoma requiring evacuation (OR 2.05, 95%CI 1.44-2.91), and cervical laceration repair (OR 1.73, 95%CI 1.27-2.36). There was a trend towards increased risk of thromboembolic events in forceps deliveries (OR 2.93, 95%CI 1.00-8.62). When a combination of both instruments was used, third/fourth degree lacerations were increased compared to both vacuum (OR 2.77, 95% CI 2.36-3.26) and forceps (OR 1.39, 95% CI 1.80-1.64). Postpartum hemorrhage was increased compared to vacuum as well (OR 1.81, 95% CI 1.33-2.47). Compared to forceps deliveries, vacuum deliveries were more associated with shoulder dystocia (OR 1.43, 95% CI 1.28-1.60). Forceps had the lowest failure rate (2.14%), followed by increased failure rates in combined use (3.66%, OR 1.85, 95% CI 1.22-2.79) and vacuum (5.60%, OR 2.65, 95% CI 2.37-2.97). CONCLUSION: Forceps delivery is the most successful in achieving vaginal delivery but appears to be associated with several delivery-related morbidities. Combining both vacuum and forceps is more successful than vacuum alone, but is no better than forceps alone, and is associated with even further morbidity. These results, in conjunction with each method’s neonatal risks, should be considered prior to contemplating use of vacuum, forceps, or both at delivery.