title: Maternal and neonatal immediate effects of sequential delivery.
abstract: OBJECTIVE
  To evaluate the immediate maternal and neonatal outcomes associated with sequential instrumental delivery (vacuum plus forceps) compared with the use of one instrument only (forceps or vacuum).
  
  
  METHODS
  A longitudinal observational study was carried out, including all instrumental deliveries performed in term singleton pregnancies, in vertex presentation, at station level 0 or +1. According to the type of the instruments, the deliveries were divided in three groups: the vacuum group, the forceps group and the sequential group. Immediate maternal and neonatal outcomes were evaluated.
  
  
  RESULTS
  A total of 275 instrumental deliveries were performed: 126 (45.5%) vacuum assisted deliveries, 62 (22.6%) forceps assisted deliveries and 87 (31.6%) sequential deliveries. Regarding maternal morbidity, there was a significant difference between the three groups (p < 0.001), with a higher rate of complications in the sequential group. The type of instrument was the only factor associated with significant maternal morbidity. The rate of immediate neonatal morbidity was 4.4% and there was no significant association with the instrument type or with other identifiable factors.
  
  
  CONCLUSIONS
  Sequential delivery is associated with a higher maternal morbidity and it seems not to increase neonatal morbidity.
authors: Department of Obstetrics, Gynecology and Reproductive Medicine, Santa Maria University Hospital, Lisbon, Portugal. baratasonia@gmail.com
authors: Sónia
authors: S
authors: Barata
authors: Edite
authors: E
authors: Cardoso
authors: Susana
authors: S
authors: Ferreira Santo
authors: Nuno
authors: N
authors: Clode
authors: Luis
authors: L
authors: Mendes Graça
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008137:Longitudinal Studies; D011247:Pregnancy; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects* / Q000706:statistics & numerical data