title: Occurrence and predictors of vacuum and forceps used sequentially for vaginal birth.
abstract: BACKGROUND
  Sequential use of vacuum and obstetric forceps for vaginal delivery is associated with increased risks of adverse maternal and infant outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study to estimate the frequency of sequential use of vacuum and forceps for planned vaginal delivery and to identify predictors, using data collected in Ontario between 2004 and 2007. Multivariate logistic regression models were used to estimate the adjusted odds ratios and 95% confidence intervals of predictors of sequential use of vacuum and forceps.
  
  
  RESULTS
  Of 186 988 pregnant women with a singleton, vertex presentation at term and a planned vaginal birth, 1062 (0.57%) required the sequential use of vacuum and forceps for delivery. The major predictors for sequential use of vacuum and forceps were mother's primary language being other than English or French, nulliparity, a history of Caesarean section, dystocia, use of epidural or other pain relief, labour induction, labour augmentation, fetal macrosomia, and advanced gestational age.
  
  
  CONCLUSIONS
  In this population-based study we found that 0.57% of planned vaginal births were delivered with sequential use of vacuum and obstetric forceps. Abnormal labour, fetal macrosomia, language barriers, and advanced gestational age are significant predictors of requiring this sequential use.
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Huaihua Medical College, Hunan, P.R. China; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa ON.
authors: Ri-Hua
authors: RH
authors: Xie
authors: BORN Ontario (Better Outcomes Registry and Network), Ottawa ON.
authors: Huiling
authors: H
authors: Cao
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.
authors: Bo
authors: B
authors: Hong
authors: BORN Ontario (Better Outcomes Registry and Network), Ottawa ON.
authors: Ann E
authors: AE
authors: Sprague
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa ON; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa ON.
authors: Mark
authors: M
authors: Walker
authors: OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa ON; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa ON.
authors: Shi
authors: S
authors: Wu Wen
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D004420:Dystocia; D005260:Female; D005320:Fetal Macrosomia; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced; D007802:Language; D009772:Obstetrical Forceps / Q000706:statistics & numerical data*; D009864:Ontario; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical / Q000379:methods* / Q000706:statistics & numerical data*
keywords: forceps; predictors; vacuum extraction