Maternal and neonatal morbidity in relation to the instrument used for mid‐cavity rotational operative vaginal delivery: a prospective cohort study. Issue 12 (7th August 2013)

• Record Type: Journal Article
• Authors: Bahl, R; Van de, M; Macleod, M; Strachan, B; Murphy, DJ
• Is Part Of: BJOG. Volume 120:Issue 12(2013:Dec.)
• Page Start: 1526
• Page End: 1533
• Publication Date: 2013-08-07
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12398
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12398-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12398-sec-0001" sec-type="section"> <title>Objective</title> <p>To compare the maternal and neonatal morbidity associated with alternative instruments used to perform a mid‐cavity rotational delivery.</p> </sec> <sec id="bjo12398-sec-0002" sec-type="section"> <title>Design</title> <p>A prospective cohort study.</p> </sec> <sec id="bjo12398-sec-0003" sec-type="section"> <title>Setting</title> <p>Two university teaching hospitals in Scotland and England.</p> </sec> <sec id="bjo12398-sec-0004" sec-type="section"> <title>Population</title> <p>Three hundred and eighty‐one nulliparous women who had a mid‐cavity rotational operative vaginal delivery.</p> </sec> <sec id="bjo12398-sec-0005" sec-type="section"> <title>Methods</title> <p>A data collection sheet was completed by the research team following delivery.</p> </sec> <sec id="bjo12398-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Postpartum haemorrhage, third‐ and fourth‐degree perineal tears, low cord pH, neonatal trauma, and failed or sequential operative vaginal delivery.</p> </sec> <sec id="bjo12398-sec-0007" sec-type="section"> <title>Results</title> <p>One hundred and sixty‐three women (42.8%) underwent manual rotation followed by non‐rotational forceps delivery, 73 (19.1%) had a rotational vacuum delivery, and 145 (38.1%) delivered with the assistance of rotational (Kielland) forceps. The rates of postpartum haemorrhage were similar when comparing manual rotation with rotational vacuum (adjusted OR 1.42, 95% CI 0.66–3.98), and when comparing manual rotation with Kielland forceps (adjusted OR 1.22, 95% CI 0.71–2.88). The results were comparable for third‐ and fourth‐degree perineal tears (adjusted OR 0.85, 95% CI 0.13–1.89; adjusted OR 0.94, 95% CI 0.39–1.82), low cord pH (adjusted OR 1.76, 95% CI 0.44–6.91; adjusted OR 1.12, 95% CI 0.44–2.83), neonatal trauma (adjusted OR 0.50, 95% CI 0.16–1.55; adjusted OR 3.25, 95% CI 0.65–16.17), and admission to the neonatal intensive care unit (adjusted OR 1.47, 95% CI 0.45–4.81; adjusted OR 1.04, 95% CI 0.49–2.19). The sequential use of instruments was less likely with manual rotation and forceps than with rotational vacuum delivery (0.6 versus 36.9%, OR 0.01, 95% CI 0.002–0.090).</p> </sec> <sec id="bjo12398-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Maternal and perinatal outcomes are comparable with Kielland forceps, vacuum extraction, and manual rotation, with few serious adverse outcomes. With appropriate training mid‐cavity rotational delivery can be practiced safely, including the use of Kielland forceps.</p> </sec> </abstract>