title: Neonatal outcomes and operative vaginal delivery versus cesarean delivery.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology at Wake Forest University, Winston-Salem, North Carolina, USA. scontag@lifebridgehealth.org
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Contag
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Clifton
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bloom
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.forename: Marshall W
authors.initials: MW
authors.lastname: Carpenter
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
mesh_terms: 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