3 In addition, no differences in bowel or bladder function were found between women delivered by forceps versus vacuum extraction at 5 years. However, despite this higher rate of perineal trauma, when compared with outcomes for cesarean delivery, forceps delivery was not associated with higher rates of pelvic floor or sexual dysfunction in primiparous women 1 year postpartum. Vaginal birth is more likely to be achieved with forceps than with vacuum extraction, but the former has about twice the rate of associated 3rd- or 4th-degree perineal tears. While the Practice Bulletin retains the traditional classification system for outlet, low and mid-forceps deliveries (see Box 2), ACOG points out that in general, the lower the fetal head in the pelvis and the less rotation required, the less the risk of maternal and fetal injury. Recommended: Are we too quick to turn to cesarean delivery? In cases of nonreassuring fetal heart rate (FHR) tracings, operative vaginal delivery may not only obviate the short- and long-term maternal morbidities of cesarean delivery but avoid progressive fetal ischemia. Such factors include preexisting cardiovascular disease, deteriorating medical conditions (eg, hypertension, sepsis), prolonged second stage of labor, arrest of descent or the need to rotate the fetal head to effect vaginal delivery. The former include exhaustion and ineffectual pushing in the second stage of labor as well as various medical and obstetrical factors requiring an expedited second stage. Operative vaginal delivery is indicated for both maternal and fetal reasons. The latest ACOG Practice Bulletin on this subject serves as an excellent summary of the indications, prerequisites, advantages, and overall safety of this increasingly lost art. Whereas in 1990 slightly more than 9% of livebirths resulted from either forceps delivery (5.11%) or vacuum extraction (3.9%), by 2014 only 3.21% of livebirths resulted from operative vaginal delivery and forceps accounted for less than 20% of these births (0.57% of all live births). I suspect many practitioners of my generation compiled similar numbers during their training. When I was a resident I performed more than 250 operative vaginal deliveries, mostly with forceps, and many after rotation. Lockwood is Senior Vice President, USF Health and Dean, Morsani College of Medicine, University of South Florida, Tampa, FL, and Editor in Chief of Contemporary OB/GYN. The purpose of this document is to provide a review of the current evidence regarding the benefits and risks of operative vaginal delivery.ĭr. Use of obstetric forceps or vacuum extractor requires that an obstetrician and obstetric care provider be familiar with the proper use of the instruments and the risks involved. OPERATIVE VAGINAL DELIVERY Despite significant changes in management of labor and delivery over the past few decades, operative vaginal delivery remains an important component of modern labor management, accounting for 3.30% of all deliveries in 2013 (1). Full text of ACOG Practice Bulletin available to ACOG members at. American College of Obstetricians and Gynecologists. COMMITTEE ON PRACTICE BULLETINS-Obstetrics Practice Bulletin No.
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