title: Choosing between bad, worse and worst: what is the preferred mode of delivery for failure of the second stage of labor?
abstract: OBJECTIVE
  To determine the preferred mode of delivery (vacuum, forceps or cesarean delivery) for second-stage dystocia.
  
  
  METHODS
  Retrospective cohort study of women delivered by forceps, vacuum or cesarean delivery due to abnormalities of the second stage of labor. Primary outcome included neonatal and maternal composite adverse effects.
  
  
  RESULTS
  A total of 547 women were included: 150 (27.4%) had forceps delivery, 200 (36.5%) had vacuum extraction, and 197 (36.1%) had cesarean section. The rate of neonatal composite outcome was significantly increased in vacuum extraction (27%) compared to forceps delivery (14.7%) or cesarean section (9.7%) (p < 0.001). There was no difference in the rate of maternal composite outcome among the groups. Both operative vaginal delivery modes were associated with significantly lower rate of postpartum infection compared to cesarean delivery (0% versus 3%, p = 0.004).
  
  
  CONCLUSIONS
  Operative vaginal delivery was associated with reduced postpartum infection compared to cesarean section. Forceps delivery was associated with reduced risk for adverse neonatal outcome compared to vacuum extraction, with no increase in the risk of composite maternal complications.
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: I
authors.initials: I
authors.lastname: Hendler
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: M
authors.initials: M
authors.lastname: Kirshenbaum
authors.affiliation: b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: M
authors.initials: M
authors.lastname: Barg
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: S
authors.initials: S
authors.lastname: Kees
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: S
authors.initials: S
authors.lastname: Mazaki-Tovi
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: O
authors.initials: O
authors.lastname: Moran
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: A
authors.initials: A
authors.lastname: Kalter
authors.affiliation: a Department of Obstetrics and Gynecology , Sheba Medical Center, Tel Hashomer , Ramat Gan , Israel and.|b Sackler School of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: E
authors.initials: E
authors.lastname: Schiff
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications; D009772:Obstetrical Forceps / Q000009:adverse effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011645:Puerperal Infection / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects
keywords: Cesarean section; forceps; operative vaginal delivery; second stage dystocia; vacuum