title: Temporal trends and morbidities of vacuum, forceps, and combined use of both.
abstract: OBJECTIVE
  To assess trends over time of operative vaginal delivery and compare delivery-related morbidity between vacuum delivery, forceps delivery, or combined use of both in California.
  
  
  METHODS
  California ICD-9 discharge data from 2001 to 2007 were used to identify cases of forceps and vacuum delivery.
  
  
  RESULTS
  There was a decline in all operative delivery types (9.0% in 2001 to 7.6% in 2007), with the decline in the use of forceps most pronounced (7.26/1000 deliveries in 2001 to 3.85/1000 in 2007). Higher rates of third/fourth degree lacerations, postpartum hemorrhage, manual extraction of placenta, pelvic hematoma requiring evacuation, cervical laceration repair, and thromboembolic events were noted in forceps compared to vacuum deliveries. When both instruments were used, rates of third/fourth degree lacerations and postpartum hemorrhage were increased. Operative delivery failure was highest in combined use compared to forceps or vacuum alone.
  
  
  CONCLUSIONS
  The incidence of operative vaginal delivery in California is declining, with decreasing use of forceps most notable. Several maternal morbidities are increased in forceps and combined deliveries compared to vacuum deliveries. There is a significantly higher risk of failure when two operative delivery methods are employed. These findings may be contributing to the declining willingness of providers to perform operative vaginal delivery.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Irvine Medical Center , Orange, CA , USA .
authors.forename: Alex
authors.initials: A
authors.lastname: Fong
authors.forename: Erica
authors.initials: E
authors.lastname: Wu
authors.forename: Deyu
authors.initials: D
authors.lastname: Pan
authors.forename: Judith H
authors.initials: JH
authors.lastname: Chung
authors.forename: Dotun A
authors.initials: DA
authors.lastname: Ogunyemi
mesh_terms: D000293:Adolescent; D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008875:Middle Aged; D009017:Morbidity; D009772:Obstetrical Forceps / Q000009:adverse effects*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D014618:Vacuum; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation / Q000706:statistics & numerical data; D055815:Young Adult
keywords: California; incidence; operative vaginal delivery; outcomes; population-based study