title: What to do after a failed attempt of vacuum delivery?
abstract: OBJECTIVE
  To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery.
  
  
  METHODS
  A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4).
  
  
  RESULTS
  Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups.
  
  
  CONCLUSIONS
  If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.
authors.affiliation: Department of Obstetrics and Gynecology, Sackler Faculty of Medicine, Edith Wolfson Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Oscar
authors.initials: O
authors.lastname: Sadan
authors.forename: Shimon
authors.initials: S
authors.lastname: Ginath
authors.forename: Andrei
authors.initials: A
authors.lastname: Gomel
authors.forename: Dora
authors.initials: D
authors.lastname: Abramov
authors.forename: Sigi
authors.initials: S
authors.lastname: Rotmensch
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Marek
authors.initials: M
authors.lastname: Glezerman
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D000740:Anemia / Q000453:epidemiology; D001034:Apgar Score; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D005316:Fetal Distress; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007748:Labor Stage, Second; D007902:Length of Stay; D008470:Meconium; D009772:Obstetrical Forceps; D011247:Pregnancy; D011256:Pregnancy Outcome; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012782:Shoulder; D013997:Time Factors; D017211:Treatment Failure; D014620:Vacuum Extraction, Obstetrical