914: Second stage of labor: Maternal and perinatal outcomes of cesarean versus attempted operative vaginal delivery

Abstract

Among women who reach the second stage of labor and require operative delivery, little data exists on the maternal and perinatal outcomes based on attempted operative vaginal delivery (OVD) vs cesarean delivery (CD) without attempted OVD. The objective of this study was to compare the maternal and perinatal outcomes among these two groups. This is a secondary analysis of data from a multicenter prospective study for women enrolled in the Cesarean Registry. We compared the maternal and perinatal outcomes based on whether OVD was attempted or CD was performed without attempt. This study includes singleton, at > 37 weeks, pregnancies that were eligible for OVD (10cm dilated and +2 station). Exclusion criteria included those who underwent CD in second stage with primary indication of non-reassuring fetal heart rate tracing and those with anomalous fetuses. Primary outcome was composite maternal morbidity and secondary outcome was composite neonatal morbidity. A multivariable Poisson regression analysis was used to examine the association between attempt of OVD and outcomes, while adjusting for potential confounding factors that were different between groups at a p value of < 0.1 in univariate analysis. A total of 1,432 women met the inclusion criteria: 1,025 (71%) had an attempted OVD and 407 underwent CD without attempt (39%). Women who attempted OVD were more likely to have composite maternal morbidity (aRR 2.93, 95% CI 1.92-4.49), mostly from third and fourth degree perineal lacerations (Table 1). There was no significant difference in rates of composite neonatal morbidity between groups; however, neonatal birth injury was significantly more frequent in the group who had an attempted OVD (aRR 4.79, 95% CI 1.85-12.42)(Table 2). In women reaching the second stage, CD without attempt was associated with lower maternal morbidity and less neonatal birth injury. Given that OVD training is declining in residency programs, these data may have clinical implications regarding counseling of patients eligible for OVD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)