Re: Forceps vs. vacuum
From: Peter Wein (pwein@unimelb.edu.au)
Sat Dec 3 22:47:38 2005
The rates of 3rd and 4th degree tear seems extraordinarily high. We
discussed this article in our jounral club - Aldo Vacca, who invented
the Kiwi Omnicup was there. It is a study over a very long period, using
lots of operators, with old-fashioned cups. We were surprised it slipped
past the editors.
Peter
Dr. Ainsworth wrote:
>For you "men of steel," I thought this article in the November Green
>journal made some interesting points:
>
>Forceps Compared With Vacuum
>Rates of Neonatal and Maternal Morbidity
>Aaron B. Caughey, MD, MPP, Per L. Sandberg, MD, Marya G. Zlatnik, MD,
>MMS, Mari-Paule Thiet, MD, Julian T. Parer, MD, PhD and Russell K.
>Laros, Jr, MD
>>From the Department of Obstetrics, Gynecology and Reproductive Sciences,
>University of California, San Francisco; and the Department of
>Obstetrics and Gynecology, California Pacific Medical Center, San
>Francisco, California.
>
>OBJECTIVE: To compare perinatal outcomes between forceps- and
>vacuum-assisted deliveries. Our hypothesis was that the force vectors
>achieved in forceps delivery will lead to fewer shoulder dystocias, but
>greater perineal lacerations.
>
>METHODS: This was a retrospective cohort study of 4,120 term, cephalic,
>singleton, nonrotational operative vaginal deliveries at a single
>institution. Outcomes examined included rates of neonatal trauma,
>shoulder dystocia, and perineal lacerations. Potential confounders,
>including maternal age, birthweight, ethnicity, parity, station at
>delivery, episiotomy, attending physician, anesthesia, and length of
>labor, were controlled for using multivariate logistic regression.
>
>RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%)
>vacuum-assisted deliveries, the rate of shoulder dystocia was lower
>among women undergoing forceps delivery (1.5% compared with 3.5%, P <
>.001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P <
>.001), whereas the rate of third- or fourth-degree perineal laceration
>was higher (36.9% compared with 26.8%, P < .001). These differences in
>perinatal complications persisted when controlling for the confounders
>listed above. The adjusted odds ratio for shoulder dystocia was 0.34
>(95% confidence interval [CI] 0.20–0.57), for cephalohematoma was 0.25
>(95% CI 0.19–0.33), and for third- or fourth-degree lacerations was 1.79
>(95% CI 1.52–2.10) when comparing forceps to vacuum.
>
>CONCLUSION: Vacuum-assisted vaginal birth is more often associated with
>shoulder dystocia and cephalohematoma. Forceps delivery is more often
>associated with third- and fourth-degree perineal lacerations. These
>differences in complications rates should be considered among other
>factors when determining the optimal mode of delivery.
>
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