Operative Vaginal Delivery and Neonatal and Infant Adverse Outcomes: Population-Based Retrospective Analysis

Abstract

Vacuum extraction has continued to replace forceps delivery in the United States and in the year 2000 accounted for approximately two thirds of all operative vaginal deliveries, compared with 41% in 1990. The U.S. Food and Drug Administration has expressed concern about fatal complications from vacuum-assisted deliveries, including intracranial bleeding. The authors carried out a retrospective population-based study comparing neonatal morbidity and mortality from these 2 methods. Two cohorts of live singleton births were analyzed: 11,639,388 in the United States and 375,351 in New Jersey. The New Jersey mothers were older than those in the U.S. cohort. Nulliparous women were likely to deliver by either vacuum or forceps. Fetal distress was more frequent in instrumental deliveries. Gestational ages were similar in the 2 treatment groups. Neonatal mortality was similar in vacuum and forceps deliveries (odds ratio, 0.94; 95% confidence interval, 0.79–1.12). In the U.S. cohort, vacuum extraction was associated with fewer birth injuries and neonatal seizures and with a lesser need for assisted ventilation. Among New Jersey births, vacuum extraction was likelier than forceps delivery to be complicated by postpartum bleeding and shoulder dystocia (respective odds ratios, 1.22 and 2.00). The 2 methods were associated with similar risks of intracranial hemorrhage, retinal hemorrhage, and feeding problems. When vacuum and forceps were used sequentially, there was a greater chance that mechanical ventilation would be needed, and the risk of third- and fourth-degree perineal tears was increased. All of these findings were replicated after excluding preterm births.