Forceps Delivery Rate Research Articles

Impacts of individualized birth process management on birth outcomes of low-risk parturient unipara

Objective To study the impact of individualized birth process management on birth outcomes of low-risk parturient unipara. Methods 729 parturient women were divided into the experimental group （ n = 503 ） and the control group （ n = 226）. The free position during labor was used in the control group. In the experimental group, individualized labor movements and pre-delivery positions were provided to improve the birth outcome. The incidence of emergency cesarean section and use of obstetric forceps were compared between groups. Results A total of 468 parturient women in the experimental group were in spontaneous labor, with an incidence of 93.04% ; 198 parturient women in the control group were in spontaneous labor, with an incidence of 87.6%. The use of obstetric forceps in the experimental group was 1.59% , which was lower than 3.98% in the control group. Twenty-six parturient women in the experimental group went through emergency cesarean section, with an incidence of 5.17% ; nineteen parturient women in the control group went through emergency cesarean section, with an incidence of 8.41%. The difference was significant between groups （χ^2 = 6. 97 ,P 〈0. 05）. The most frequent labor position in the experimental group was semireelining position, with an incidence of 90. 46%. The least use labor position was kneeling-squatting position, with an incidence of 4. 57%. Conclusions The Individualized birth process management can significantly decrease the rate of emergent cesarean and forceps delivery. Key words: Parturient women ; Spontaneous labor; Stage of labor; Delivery position; Birthoutcome

Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences

ObjectiveTo examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period. Study designThis retrospective analysis of prospectively gathered data was carried out at a large tertiary referral center from 1991 to 2010. All cases of operative vaginal delivery during the study period were recorded. The rates of instrumental delivery, as well as neonatal outcomes and instrument preference, were compared for individual 5-year epochs. ResultsDuring the study period there were 156,130 deliveries of which 17,841 were operative vaginal deliveries, an incidence of 11.4/100 deliveries and 13.6/100 vaginal deliveries. There was an increase in the rate of operative vaginal delivery across the 20-year period (P<0.0001; R2=0.85; Slope=0.42). When individual 5-year epochs were compared, the incidence of instrumental delivery increased from 7.3% (2340/31,937) in the first five years, 1991–1995, to 13.7% (6179/45,177) in the final five years, 2006–2010 (P<0.0001; OR 2.34, 95% CI=2.23–2.47). The perinatal mortality rate in cases of instrumental delivery was decreased when these time periods were compared (7.3/1000 (17/2340) vs. 1.8/1000 (11/6179); P=0.003, OR 0.24, 95% CI=0.11–0.52). The choice of instrument also varied, with 68.2% (1596/2340) of instrumental deliveries in 1991–1995 being carried out with forceps compared to 32.9% (2033/6179) in 2006–2010 (P<0.001). ConclusionRates of operative vaginal delivery have increased over the 20-year study period. The rate of perinatal mortality in infants who had an assisted vaginal delivery was decreased in the 5-year epoch at the end of the study compared with the period at the beginning. The rate of forceps delivery has fallen significantly, with vacuum delivery now being the choice of the majority of clinicians.

Changing trends in modes of delivery in the dublin maternity hospitals over a decade

ObjectiveTo describe the changing trends in modes of delivery, in a single large urbanIrish population over the past 10 years.Study designA retrospective review of the modes of all deliveries in...

Características da assistência ao trabalho de parto e parto em três modelos de atenção no SUS, no Município de Belo Horizonte, Minas Gerais, Brasil

This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27.9%, 59.5%, and 40.1%, while amniotomy was performed in 67.6%, 73.6%, and 82.2% of the women, respectively. Episiotomy rates were lower in the first two facilities, which have adopted patient-centered obstetric practices (7.2% at the birthing center and 14.8% at the award-winning hospital) as compared to 54.9% at the standard maternity facility. The liberal offer of epidural anesthesia at the awarding-winning hospital resulted in a higher anesthesia rate (54.4%) as compared to the standard facility (7.7%). Forceps delivery and neonatal admission rates were higher in the standard hospital, but there were no differences in mean Apgar or cesarean rates. The findings suggest resistance to selective use of interventions in all three models of obstetric care, although favoring the birthing center as a strategy for controlling interventions during labor and childbirth in low-risk pregnancies, with no resulting harm to the mothers or newborns.

Forceps delivery audit poster

AimsTo audit cases where there was a forceps delivery and establish whether the rate could be reduced. This followed an increase in the rate of forceps delivery in UCLH from...

Use of modified robson group classification to interpret obstetric data relating to instrumental and normal deliveries

BackgroundSouthampton University Hospitals Trust is a tertiary centre with over 6000 deliveries annually. Despite a stable caesarean section (CS) rate of 21–22%, we have previously reported an unexplained increasing trend...

Retrospective analysis on the influence of epidural labor analgesia in delivery manner

Objective To evaluate the influence of epidural labor analgesia in delivery manner. Methods The rates of epidural analgesia, spontaneous vaginal delivery, forceps delivery and cesarean section were calculated yearly and monthly from January of 2005 to December of 2006. The data of parturients who accepted epidural analgesia but deliveried with caesarean section were collected after a initina bolus, patient-controlled epidural analgesia(PCEA) started using 0.15% ropivacaine or 0.1% ropivacaine with 2 mg/L fentanil, with a bolus of 1～5ml, lockout interval of 15min and background infusion of 5 ml/h～8 ml/h when the cervix dilated at least 2 cm. Epidural infusion stopped at the moment of complete cervical dilatation. Results Compared to that in 2005, the rate of epidural labor analgesia(21.9% vs 33.8%, P＜0.05) and the rate of spontaneous vaginal delivery increased(51.7% vs 55.2%, P＜0.05) in 2006, the rate of forceps delivery unchanged(4.4%vs 4.7%, P＞0.05) and the rate of caesarean section decreased(43.9% vs 40.1%, P＜0.05) in 2006. The monthly rate of epidural analgesia was negatively correlated to the monthly rate of cesarean section (r=-0.678, P＜0.05). Conclusion Epidural labor analgesia provides opportunities of natural delivery for parturients who request cesarean section because of fearing labor pain, it decreases the rate of caesarean section, and increases the rate of spontaneous vaginal delivery to a certain extent. Whether epidural analgesia is responsible for the case of cesarean section needs further study. Key words: Epidural analgesia; Labor manner

Fetal Pulse Oximetry and Cesarean Delivery

ABSTRACT More than 5 years ago the Food and Drug Administration approved, conditionally, the OxiFirst Fetal Oxygen Saturation Monitoring System as an adjunct to electronic fetal monitoring. The goal of monitoring was to gain more knowledge of the condition of the fetus by continuously monitoring oxygen saturation when there is a nonreassuring fetal heart rate pattern. The sensor is inserted through the dilated cervix following membrane rupture, and positioned against the fetal face. This randomized trial, conducted at 14 university-based clinical centers, was designed as a means of learning whether adjunctive fetal oximetry lessens the need for cesarean delivery. Participants were nulliparous women with a singleton fetus in cephalic presentation at 36 or more weeks' gestation. The 5341 women in the study were randomized to either “open” fetal pulse oximetry with oxygen saturation values displayed to the clinician, or “masked” oximetry in which the results were hidden. Overall rates of cesarean delivery were 26.3% for the open group and 27.5% for masked monitoring, not a significant difference. The respective operative delivery rates were 7.1% and 7.9% for a nonreassuring fetal heart rate pattern; and 18.6% and 19.2% for dystocia, Findings were similar for the 2168 women in whom a nonreassuring fetal heart rate pattern was identified before randomization. There were no significant differences between the open and masked groups in the rates of forceps or vacuum-assisted delivery, even after excluding women who had labor induced. The relative risk of cesarean delivery associated with knowing the fetal oxygen saturation was 0.96 (95% confidence interval, 0.87–1.04). Neither maternal nor infant complications differed significantly in incidence between the study groups. The sensitivity, specificity, positive predictive value, and negative predictive value of a nonreassuring fetal heart rate pattern for low oxygen saturation (defined as less than 30% for 2 consecutive minutes) were, respectively, 87%, 19.5%, 35%, and 75%. One-fourth of fetuses with a normal heart rate pattern exhibited low oxygen saturation. This large-scale study failed to demonstrate that knowledge of intrapartum fetal oxygen saturation significantly lowers the rate of cesarean delivery or improves infant outcomes. The findings emphasize the need to rigorously evaluate new technologies.

Trends in the rate of shoulder dystocia over two decades

Objective. To describe the trend in the rate of shoulder dystocia over twenty-four years and identify the risk factors related to the occurrence of dystocia.Methods. Data was obtained from Maryland State regarding all vaginal deliveries that occurred during six different time periods at five-year intervals since 1979. Trends in the rate of shoulder dystocia, episiotomy, forceps and vacuum delivery were examined.Results. There were a total of 277 974 vaginal deliveries. The overall rate of shoulder dystocia was 1.29% (n = 3590). Induction of labor (adjusted OR 1.2, 1.1–1.3), presence of diabetes (gestational (OR 1.9, 1.7–2.3) or pre-gestational (OR 3.8, 2.7–5.4)), fetal macrosomia (OR 5.1, 4.1–6.3) use of episiotomy (OR 1.6, 1.5–1.8), forceps (OR 1.3, 1.0–1.8) or vacuum (OR 2.3, 2.0–3.9) at delivery were associated with a higher rate of shoulder dystocia.Trend. There was an increase in the rate of shoulder dystocia from 0.2% in 1979 to 2.11% in 2003. In addition there was a drop in the overall episiotomy rate from 73.67% to 23.94% and increase in the use of vacuum from 0.1% to 8.36%.Conclusion. The rate of shoulder dystocia has increased by 10 fold during the study period. The use of episiotomy either at spontaneous delivery or instrumental delivery does not appear to decrease the occurrence of shoulder dystocia.

Are rural adolescents necessarily at risk of poorer obstetric and birth outcomes?

The purpose of the present study were to describe the sociodemographic and clinical characteristics of adolescent women giving birth at Wagga Wagga Base Hospital, and compare these with those with all adolescents in New South Wales. An investigative approach. Obstetric complications, delivery intervention and adverse infant outcomes. Wagga Wagga Base Hospital. One hundred and sixteen adolescents aged 15-19 years. In relation to obstetric complications and infants with complications, the study sample was found to be representative of New South Wales adolescents. However, for type of delivery there was a higher rate of forceps delivery (12.3% (15) vs 4.7% (415) P = 0.0001), forceps rotation (4.1% (5) vs 0.9% (80) P = 0.004) and fewer normal vaginal deliveries (67.2% (82) vs 80.8% (7108) P = 0.006) at Wagga Wagga Base Hospital. These findings suggest that rural adolescents are at risk of delivery complications and are less likely to have a normal vaginal delivery. More research is required into obstetric and birth outcomes for the rural adolescent population.

Poster 19: Trends in the Occurrence of Obstetric Anal Sphincter Lacerations Over the Past 3 Decades in the State of Maryland

OBJECTIVE: The objective of this study was to identify change in the use of obstetric procedures since 1979 and possible correlation among episiotomy, instrumental vaginal delivery, and obstetric anal sphincter laceration in the state of Maryland. METHODS: Data was obtained from the State of Maryland database regarding all vaginal deliveries that occurred during 6 different time periods at 5-year intervals since 1979. Rate of anal sphincter laceration was calculated in women who had spontaneous vaginal delivery and compared with those who had an episiotomy and/or instrumentation during delivery. Logistic regression was used to adjust for confounders. RESULTS: There were a total of 22,267 (8%) anal sphincter lacerations during the years studied. The rate was highest when instrumental vaginal delivery was performed with episiotomy (21.57% or one in 5), and lowest when neither episiotomy nor instrumentation was used at delivery (3.92% or approximately one in 25). SIGNIFICANT TRENDS: The rate of anal sphincter lacerations was 8.55% in the year 1979 and then decreased gradually to 4.94% in 2003. There was a tremendous drop in the rate of forceps delivery from 31.71% in 1979 to 1.44% in 2003. Although almost all instrumental vaginal deliveries in the earlier years were performed with episiotomy, in 2003, in 46% cases, instrumentation was used without episiotomy. The rate of episiotomy overall also decreased from 73.67% to 23.94% from 1979 to 2003. CONCLUSION: There was a gradual decrease in the rate of third-and fourth-degree lacerations over the past 24 years. This corresponds to a decrease in the use of episiotomy, decreased rate of operative delivery, and decreased forceps use.

Outcome of Instrumental Deliveries in Lagos Nigeria Implications For its Use at the Second Tier Healthcare Level

The case notes of patients undergoing instrumental delivery at the Lagos University Teaching Hospital between 1st January 1994 and 31st December 1996 were analysed. The overall instrumental delivery rate was 4.9% with an overall forceps delivery rate of 1.8% and vacuum extraction rate of 2.9%. Vacuum extraction was used in 59.4% of cases and forceps in 36.3% to assist vaginal delivery. Patients aged 20-29years accounted for 57% and nulliparous patients 67% of those Undergoing instrumental delivery. In 47.7% of cases the procedure was elective. The commonest indication being pre-eclampsia and eclampsia (25.4%). Prolonged second stage in 28.4% of cases was the commonest indication for emergency delivery. Maternal complications were twice as common in patients undergoing forceps delivery (26.9%) as opposed to vacuum extraction (13.8%). Neonatal complications were more common following forceps delivery (37.9%) compared to vacuum extraction (13.4%) There were four neonatal deaths all following forceps delivery. Vacuum extraction appears to be a safer method of instrumental delivery than the obstetric forceps. Maternal and perinatal morbidity and mortality may benefit from the training of midwives and non-specialist doctors in the procedure of vacuum extraction in an emergency at the secondary health care level. Key Words: Instrumental delivery, secondary health care, Lagos Nigeria. Nigerian Medical Practitioner Vol. 45 No 6, 2004 (106-110)

Forceps delivery and the use of synthetic opioid analgesia during epidural anaesthesia

Objective: To verify whether the use of sufentanil during obstetric epidural anaesthesia (EA) was accompanied by an increase in the rate of instrumental extraction. Study design: We made a retrospective comparison of deliveries that occurred during two 3-year periods (1993–1995, and 1997–1999), before and after the introduction of sufentanil into our protocol for epidural anaesthesia. Results: The first period covered 4694 deliveries compared with 5310 in the second; for these periods, the EA rate rose from 48.55 to 63.36% ( P=0.0001). The rates of uncomplicated vaginal delivery, forceps delivery and caesarian section over the two periods were 70.24, 12.76 and 17% versus 67.08, 14.41 and 18.51%, respectively: the differences were statistically significant. The indications for the use of forceps did not differ during the two periods. During vaginal delivery, the rate of forceps use as a function of EA administration/non-administration was remarkably constant over the two periods: 25.8% with EA versus 6.2% without EA in the first period compared with 24.9 and 6.2% in the second period. The forceps delivery rate was unaffected by the fact that EA was carried out by an anaesthetist specialised in obstetrics. Conclusion: The addition of sufentanil to our protocol for EA has not altered the practice of instrumental extraction in our department. With EA, the rate of forceps delivery is multiplied by 4, irrespective of the protocol used.

Obstetric attending physician characteristics and their impact on vacuum and forceps delivery rates: University of California at San Francisco experience from 1977 to 1999

Objective: The objective of our study was to determine the impact of obstetric attending physician characteristics (eg, region of previous residency training, sex, year of graduation from residency) on the rates of vacuum and forceps delivery at our institution. Study Design: The analysis was based on 19,897 vaginal deliveries that were performed by 171 attending physicians and 160 resident physicians between 1977 and 1999 at the University of California at San Francisco Medical Center. Z -tests and multivariate logistic regression were performed on a perinatal database that contained standard obstetric variables. Results: Male attending physicians had a higher percentage of forceps deliveries compared with female attending physicians (11.1% vs 6.6%; P <.001); female attending physicians had a higher percentage of vacuum deliveries compared with male attending physicians (9.8% vs 5.1%; P <.001). However, multivariate regression analysis revealed that only the year in which the procedure was performed affected both the forceps and vacuum delivery rates (P <.041). The region of previous residency training of the attending physician affected the vacuum delivery rate (P <.0001) but not the forceps delivery rate (P >.06) in multivariate logistic regression analysis. Factors such as the sex of the obstetric attending physician, the sex of the resident, and the year of graduation from residency for the obstetric attending physician did not have a significant impact on the forceps or vacuum delivery rates (all P >.05). Conclusion: Our study is the first to report that the apparent gender differences in forceps and vacuum delivery rates among obstetric attending physicians was due to the year in which the procedure was performed and not due to sex per se. We also found that the region of previous residency training for the obstetric attending physician significantly influenced the vacuum delivery rate. (Am J Obstet Gynecol 2002;186:1299-303.)

▪ The Effect of Obstetric Resident Gender on Forceps Delivery Rate

▪ The Effect of Obstetric Resident Gender on Forceps Delivery Rate

The effect of obstetric resident gender on forceps delivery rate

Objective: This study was undertaken to examine the effect of obstetric resident physician gender on the forceps delivery rate. Study Design: Analysis was based on >350,000 deliveries performed by >800 residents in obstetrics and gynecology throughout the United States from 1994 to 1998. A χ 2 analysis was performed on resident statistics from residency review committee report forms. Results: The percentage of total deliveries performed with forceps during residency was significantly higher among male residents ( P < .0001), as was the percentage of vaginal deliveries performed with forceps during residency ( P < .0001). The percentage of overall operative vaginal deliveries (vacuum plus forceps) was significantly higher for male residents ( P < .0001); however, the percentage of vacuum deliveries did not vary according to gender of the resident when considered independently. Conclusion: These results strongly suggest that resident gender affects performance of forceps delivery. (Am J Obstet Gynecol 2000;182:1050-1.)

Effects of Providing Hospital-Based Doulas in Health Maintenance Organization Hospitals

In Brief Objective To evaluate whether providing doulas during hospital-based labor affects mode of delivery, epidural use, breast-feeding, and postpartum perceptions of the birth, self-esteem, and depression. Methods This was a randomized study of nullipara enrollees in a group-model health maintenance organization who delivered in one of three health maintenance organization–managed hospitals; 149 had doulas, and 165 had usual care. Study data were obtained from the mothers' medical charts, study intake forms, and phone interviews conducted 4–6 weeks postpartum. Results Women who had doulas had significantly less epidural use (54.4% versus 66.1%, P < .05) than women in the usual-care group. They also were significantly (P < .05) more likely to rate the birth experience as good (82.5% versus 67.4%), to feel they coped very well with labor (46.8% versus 28.3%), and to feel labor had a very positive effect on their feelings as women (58.0% versus 43.7%) and perception of their bodies' strength and performance (58.0% versus 41.0%). The two groups did not differ significantly in rates of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administration; or breast-feeding, nor did they differ on the postpartum depression or self-esteem measures. Conclusion For this population and setting, labor support from doulas had a desirable effect on epidural use and women's perceptions of birth, but did not alter need for operative deliveries. Labor support from a doula significantly reduces epidural use and improves perceptions of childbirth but does not reduce need for operative deliveries.

Effects of providing hospital-based doulas in health maintenance organization hospitals

Objective: To evaluate whether providing doulas during hospital-based labor affects mode of delivery, epidural use, breast-feeding, and postpartum perceptions of the birth, self-esteem, and depression. Methods: This was a randomized study of nullipara enrollees in a group-model health maintenance organization who delivered in one of three health maintenance organization–managed hospitals; 149 had doulas, and 165 had usual care. Study data were obtained from the mothers’ medical charts, study intake forms, and phone interviews conducted 4–6 weeks postpartum. Results: Women who had doulas had significantly less epidural use (54.4% versus 66.1%, P < .05) than women in the usual-care group. They also were significantly ( P < .05) more likely to rate the birth experience as good (82.5% versus 67.4%), to feel they coped very well with labor (46.8% versus 28.3%), and to feel labor had a very positive effect on their feelings as women (58.0% versus 43.7%) and perception of their bodies’ strength and performance (58.0% versus 41.0%). The two groups did not differ significantly in rates of cesarean, vaginal, forceps, or vacuum delivery, oxytocin administration; or breast-feeding, nor did they differ on the postpartum depression or self-esteem measures. Conclusion: For this population and setting, labor support from doulas had a desirable effect on epidural use and women’s perceptions of birth, but did not alter need for operative deliveries.

Regional differences in operative obstetrics: a look to the South

Objective: To compare operative delivery rates across regions of the United States from 1987 to 1994 and to evaluate how the rates of severe obstetric lacerations changed during the same period. Methods: I used diagnosis and procedure data from the National Hospital Discharge Survey and natality data from the National Center for Health Statistics to describe temporal and regional variations in the rates of cesarean, forceps, and vacuum delivery. I described temporal trends in the rates of cervical and severe perineal lacerations during the same period. I performed exploratory analyses of detailed 1990 data to test for regional differences in demographic risk factors that might explain differences in operative delivery rates. Results: Between 1987 and 1994, cesarean delivery rates fell from approximately 25% to less than 22% in all regions except the South. Operative vaginal delivery rates were stable at 10–12% and were consistently lowest in the Northeast (8.2% in 1994) and highest in the South (12.9% in 1994). Vacuum surpassed forceps deliveries in all regions except the South. The rates of cervical and fourth-degree perineal lacerations declined by 57% and 40%, respectively, whereas the rate of third-degree lacerations did not decline. Demographic risk factors for cesarean delivery were no more prevalent in the South than in other regions. Age under 25 years was the only demographic risk factor for forceps delivery that was more prevalent in the South. Conclusion: In all but the southern United States, cesarean delivery rates declined and vacuum surpassed forceps delivery. These regional differences are not explained by differences in demographic risk factors.

Use of a focussed teen prenatal clinic at a military teaching hospital: model for improved outcomes of unmarried mothers.

We evaluated the utility of a focussed, multidisciplinary adolescent clinic in improving perinatal outcomes. The study population included all delivering unmarried teenagers (13-19 years) from January 1, 1993 to December 31, 1995 attending the focussed adolescent obstetrical clinic compared to a similar cohort of married teenagers (13-19 years), married 20-24 year-old patients, and unmarried 20-24 year-old patients. There were no statistical differences in chorioamnionitis, intrauterine growth retardation (IUGR), postpartum haemorrhage, maternal weight gain, mean gestational age at delivery, preterm delivery rates (<37 weeks), low birth-weight (<2,500 g), Caesarean delivery, postterm delivery rates (>41 weeks), macrosomia (>4,000 g), placental abruption, chronic hypertension, alcohol use, Apgar scores or stillbirth rates or neonatal death rates among the 4 groups studied. Statistical differences were noted in mean delivery weights (p<0.05), preeclampsia (p<0.004), gestational diabetes (p<0.01), history of substance abuse (p<0.0001), tobacco use (p<0.0001), and forceps delivery rates (p<0.004). However, in the teen cohort none of these differences appeared to adversely affect perinatal outcomes in our patients. The focussed, adolescent obstetrical clinic appears to provide perinatal morbidities equal to a low-risk, general population generating better than expected outcomes for pregnant teenagers.