Neonatal outcomes and operative vaginal delivery versus cesarean delivery.
We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.
Contag
Stephen A
SA
Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, North Carolina, USA. scontag@lifebridgehealth.org
Clifton
Rebecca G
RG
Bloom
Steven L
SL
Spong
Catherine Y
CY
Varner
Michael W
MW
Rouse
Dwight J
DJ
Ramin
Susan M
SM
Caritis
Steve N
SN
Peaceman
Alan M
AM
Sorokin
Yoram
Y
Sciscione
Anthony
A
Carpenter
Marshall W
MW
Mercer
Brian M
BM
Thorp
John M
JM
Malone
Fergal D
FD
Iams
Jay D
JD
D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D008297:Male; D009772:Obstetrical Forceps; D011247:Pregnancy; D011256:Pregnancy Outcome; D014620:Vacuum Extraction, Obstetrical