Operative vaginal delivery: outcomes for mothers and newborns

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods.

Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB).

Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p < 0.05) and III (2.9%, p < 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p > 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 ± 44.9 ml), when compared to subgroup IA (473 ± 20.7 ml; p < 0.05), group II (418 ± 24.9 ml; p < 0.05), and group III (347 ± 33.4 ml; p < 0.05). There were no differences in blood loss between the outlet OF and VE groups (p > 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p < 0.01) and in control (5.9%, p < 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the children’s hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p > 0.05).

Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.