title: Trends in operative vaginal delivery rates and associated maternal complication rates in an inner-city hospital.
abstract: OBJECTIVE
  The aims of this study were to determine trends in operative vaginal delivery rates in a large inner-city hospital and to assess associated risks.
  
  
  METHODS
  We performed a retrospective cohort study (1980-1996) of women with singleton term pregnancies who underwent operative vaginal delivery at Grady Memorial Hospital, Atlanta. Maternal complication rates were compared between forceps-assisted and vacuum-assisted methods.
  
  
  RESULTS
  There was a decline in forceps-assisted deliveries during the 1980s and an increase during the 1990s. The vacuum-assisted delivery rate was exceedingly low during the 1980s and increased during the 1990s. Women who underwent forceps-assisted delivery were more likely to be <24 years old, to be nulliparous, and to have had regional anesthesia, midline episiotomies, and infant presentations other than occipitoanterior (P <.001). Women who underwent forceps-assisted deliveries had increased risks of postpartum infection, cervical laceration, prolonged hospital stay, perineal laceration, and postpartum complications.
  
  
  CONCLUSIONS
  There were upward trends in the rates of operative vaginal delivery at this inner-city hospital. Women who underwent forceps-assisted delivery had greater rates of maternal complications than did those who underwent vacuum-assisted delivery.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
authors.forename: W N
authors.initials: WN
authors.lastname: Kabiru
authors.forename: D
authors.initials: D
authors.lastname: Jamieson
authors.forename: W
authors.initials: W
authors.lastname: Graves
authors.forename: M
authors.initials: M
authors.lastname: Lindsay
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D009774:Obstetrics / Q000639:trends*; D011204:Poverty Areas; D011247:Pregnancy; D012189:Retrospective Studies; D013525:Surgical Instruments / Q000009:adverse effects / Q000706:statistics & numerical data*; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data*