Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births.
BACKGROUND
The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section.


OBJECTIVE
To determine differences in maternal and neonatal morbidity between women who, due to anticipated difficulty, have trial of instrumental vaginal delivery in theatre and those who have immediate caesarean section for failure to progress in the second stage.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2008).


METHODS
Randomised controlled trials comparing trial of instrumental vaginal delivery (vacuum extraction or forceps) in operating theatre to immediate caesarean section for women with failure to progress in the second stage (active second stage more than 60 minutes in primigravidae).


METHODS
We identified no studies meeting our inclusion criteria.


RESULTS
No studies were included.


CONCLUSIONS
There is no current evidence from randomised trials to influence practice.
Majoko
Franz
F
Department of Obstetrics and Gynaecology, Singleton Hospital, Sketty Lane, Swansea, UK, SA2 8QA. majokof215@doctors.org.uk
Gardener
Glenn
G
D002585:Cesarean Section; D005113:Extraction, Obstetrical / Q000379:methods*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D009772:Obstetrical Forceps; D009873:Operating Rooms; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D014219:Trial of Labor