title: Predictors of failed operative vaginal delivery: a single-center experience.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel. yudavi@inter.net.il
authors.forename: Avi
authors.initials: A
authors.lastname: Ben-Haroush
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
authors.forename: Boris
authors.initials: B
authors.lastname: Kaplan
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
mesh_terms: 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