Forceps compared with vacuum: rates of neonatal and maternal morbidity.
OBJECTIVE
To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations.


METHODS
This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression.


RESULTS
Among the 2,075 (50.4%) forceps- and 2,045 (49.6%) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5% compared with 3.5%, P < .001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P < .001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9% compared with 26.8%, P < .001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95% confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95% CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95% CI 1.52-2.10) when comparing forceps to vacuum.


CONCLUSIONS
Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery.


METHODS
II-2.
Caughey
Aaron B
AB
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, 505 Parnassus Avenue, Box 132, San Francisco, CA 94143, USA. abcmd@berkeley.edu
Sandberg
Per L
PL
Zlatnik
Marya G
MG
Thiet
Mari-Paule
MP
Parer
Julian T
JT
Laros
Russell K
RK
D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D022125:Lacerations / Q000209:etiology*; D009772:Obstetrical Forceps; D010502:Perineum / Q000293:injuries*; D012189:Retrospective Studies; D012783:Shoulder Dislocation / Q000209:etiology*; D047929:Term Birth; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation