title: Influence of Patient-Level Factors on Mode of Delivery among Operative Vaginal Delivery Candidates in Modern Practice.
abstract: ObjectiveWe aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery.Study DesignCross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital.ResultsTotal 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76-2.65), nulliparity (OR = 2.06, 95% CI: 1.59-2.66), epidural (OR = 2.05, 95% CI: 1.19-3.56), maternal indication (OR = 1.53, 95% CI 1.16-2.02), older maternal age (OR 1.18, 95% CI 1.06-1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01-1.20 per hour).Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23-11.20), a perinatologist (OR = 2.51, 95% CI: 1.09-5.78), longer second stage (OR = 1.79, 95% CI: 1.65-1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01-1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01-1.04 per hour).ConclusionPatient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.
authors.affiliation: University of Colorado, School of Medicine, Aurora, Colorado.|Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado.
authors.forename: Torri D
authors.initials: TD
authors.lastname: Metz
authors.affiliation: University of Colorado, School of Medicine, Aurora, Colorado.
authors.forename: Christina
authors.initials: C
authors.lastname: Gonzalez
authors.affiliation: Department of Biostatistics and Informatics, Colorado School of Public Health at the University of Colorado Denver, Denver, Colorado.
authors.forename: Amanda A
authors.initials: AA
authors.lastname: Allshouse
authors.affiliation: Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Erick
authors.initials: E
authors.lastname: Henry
authors.affiliation: Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Sean
authors.initials: S
authors.lastname: Esplin
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000379:methods; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004420:Dystocia / Q000628:therapy; D005113:Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007748:Labor Stage, Second; D007751:Labor, Induced / Q000706:statistics & numerical data; D008423:Maternal Age; D007744:Obstetric Labor Complications / Q000628:therapy*; D010298:Parity; D010500:Perinatology / Q000706:statistics & numerical data; D011247:Pregnancy; D013997:Time Factors; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects / Q000706:statistics & numerical data