title: Sequential use of instruments at operative vaginal delivery: is it safe?
abstract: OBJECTIVE
  Our purpose was to examine maternal and neonatal outcomes in a cohort of women who underwent delivery with the sequential use of instruments.
  
  
  METHODS
  This retrospective case-control study included deliveries from May 1996 through March 1998. Charts of women who underwent delivery with the sequential use of instruments (vacuum first, then forceps, or vice versa) were identified. Two control groups (1 forceps group, 1 vacuum group) were randomly selected and matched for each case. Maternal and neonatal outcomes were abstracted and compared.
  
  
  RESULTS
  There were 34 patients in each group. There were no significant demographic differences. The vacuum group had lower rates of episiotomy (P =.01) and deep perineal lacerations (P =.014), whereas these outcomes were similar in the sequential and forceps groups. All other maternal outcomes were equivalent. There were no differences in any neonatal parameter except for superficial scalp trauma, which was more common in the vacuum group (P =.002).
  
  
  CONCLUSIONS
  We conclude that the prudent use of sequential instruments at operative vaginal delivery did not engender higher rates of maternal or neonatal morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Ezenagu
authors.forename: R
authors.initials: R
authors.lastname: Kakaria
authors.forename: J A
authors.initials: JA
authors.lastname: Bofill
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004841:Episiotomy; D005260:Female; D006801:Humans; D009772:Obstetrical Forceps; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical