Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study.
OBJECTIVE
To compare the maternal and neonatal morbidity associated with alternative instruments used to perform a mid-cavity rotational delivery.


METHODS
A prospective cohort study.


METHODS
Two university teaching hospitals in Scotland and England.


METHODS
Three hundred and eighty-one nulliparous women who had a mid-cavity rotational operative vaginal delivery.


METHODS
A data collection sheet was completed by the research team following delivery.


METHODS
Postpartum haemorrhage, third- and fourth-degree perineal tears, low cord pH, neonatal trauma, and failed or sequential operative vaginal delivery.


RESULTS
One hundred and sixty-three women (42.8%) underwent manual rotation followed by non-rotational forceps delivery, 73 (19.1%) had a rotational vacuum delivery, and 145 (38.1%) delivered with the assistance of rotational (Kielland) forceps. The rates of postpartum haemorrhage were similar when comparing manual rotation with rotational vacuum (adjusted OR 1.42, 95% CI 0.66-3.98), and when comparing manual rotation with Kielland forceps (adjusted OR 1.22, 95% CI 0.71-2.88). The results were comparable for third- and fourth-degree perineal tears (adjusted OR 0.85, 95% CI 0.13-1.89; adjusted OR 0.94, 95% CI 0.39-1.82), low cord pH (adjusted OR 1.76, 95% CI 0.44-6.91; adjusted OR 1.12, 95% CI 0.44-2.83), neonatal trauma (adjusted OR 0.50, 95% CI 0.16-1.55; adjusted OR 3.25, 95% CI 0.65-16.17), and admission to the neonatal intensive care unit (adjusted OR 1.47, 95% CI 0.45-4.81; adjusted OR 1.04, 95% CI 0.49-2.19). The sequential use of instruments was less likely with manual rotation and forceps than with rotational vacuum delivery (0.6 versus 36.9%, OR 0.01, 95% CI 0.002-0.090).


CONCLUSIONS
Maternal and perinatal outcomes are comparable with Kielland forceps, vacuum extraction, and manual rotation, with few serious adverse outcomes. With appropriate training mid-cavity rotational delivery can be practiced safely, including the use of Kielland forceps.
Department of Obstetrics & Gynaecology, St Michael's Hospital, Bristol, UK.
R
R
Bahl
M
M
Van de Venne
M
M
Macleod
B
B
Strachan
D J
DJ
Murphy
D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology*; D002585:Cesarean Section / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000601:surgery*; D009772:Obstetrical Forceps / Q000009:adverse effects; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014710:Version, Fetal / Q000009:adverse effects / Q000295:instrumentation*
Mid-cavity; morbidity; operative vaginal delivery; prospective cohort study; rotational