Predictors of failed operative vaginal delivery: a single-center experience.
OBJECTIVE
The purpose of this study was to identify factors that predict operative vaginal delivery.


METHODS
A retrospective cohort study was conducted that included all women who underwent a trial of operative vaginal delivery between 1993 and 2006 at a major tertiary center.


RESULTS
Operative vaginal delivery was attempted in 5120 of 83,351 deliveries (6.1%): 4299 vacuum extractions (84.0%) and 821 forceps deliveries (16.0%). Failures occurred in 8.6% of trials, more often with vacuum extraction (10.0% vs 1.3%; P < .001). Most vacuum extraction failures (72.6%) were followed by a trial of forceps delivery, which failed in 3.5% of cases. On multivariate logistic regression analysis, the use of forceps (vs vacuum; odds ratio [OR], 0.4; 95%CI, 0.2-0.7) and administration of analgesia (epidural: OR, 0.4 [95% CI, 0.2-0.7]; intravenous opiates: OR, 0.2 [95%CI, 0.1-0.6]) were associated with a lower risk of failure, persistent occiput posterior position (OR, 2.2; 95% CI, 1.4-3.5) and birthweight >4000 g (OR, 2.8; 95% CI, 1.6-4.9), with a higher risk.


CONCLUSIONS
Fetal weight and head position should be evaluated carefully before operative vaginal delivery, and the use of analgesia should be encouraged.
Ben-Haroush
Avi
A
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel. yudavi@inter.net.il
Melamed
Nir
N
Kaplan
Boris
B
Yogev
Yariv
Y
D000328:Adult; D016362:Analgesia, Obstetrical; D001720:Birth Injuries / Q000209:etiology; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D020567:Fetal Weight; D006801:Humans; D007746:Labor Presentation; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure