title: Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.
abstract: OBJECTIVE
  To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries.
  
  
  METHODS
  Population based study.
  
  
  METHODS
  US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file.
  
  
  METHODS
  Singleton live births in the United States (n = 11 639 388) and New Jersey (n = 375 351).
  
  
  METHODS
  Neonatal morbidity and mortality.
  
  
  RESULTS
  Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95% confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and need for assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; > or = 30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery. The sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears.
  
  
  CONCLUSIONS
  Although vacuum extraction does have risks, it remains a safe alternative to forceps delivery.
authors.affiliation: Division of Epidemiology, University of Medicine and Dentistry of New Jersey, School of Public Health, 683 Hoes Lane West, PO Box 9, Piscataway, NJ 08854, USA. demisski@umdnj.edu
authors.forename: Kitaw
authors.initials: K
authors.lastname: Demissie
authors.forename: George G
authors.initials: GG
authors.lastname: Rhoads
authors.forename: John C
authors.initials: JC
authors.lastname: Smulian
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.forename: Kishor
authors.initials: K
authors.lastname: Gandhi
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: Michael
authors.initials: M
authors.lastname: Kramer
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D009515:New Jersey / Q000453:epidemiology; D009772:Obstetrical Forceps / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*