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Am J Obstet Gynecol. 2007 Sep;197(3):308.e1-5.

Predictors of failed operative vaginal delivery: a single-center experience.

Author information

1
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel. yudavi@inter.net.il

Abstract

OBJECTIVE:

The purpose of this study was to identify factors that predict operative vaginal delivery.

STUDY DESIGN:

A retrospective cohort study was conducted that included all women who underwent a trial of operative vaginal delivery between 1993 and 2006 at a major tertiary center.

RESULTS:

Operative vaginal delivery was attempted in 5120 of 83,351 deliveries (6.1%): 4299 vacuum extractions (84.0%) and 821 forceps deliveries (16.0%). Failures occurred in 8.6% of trials, more often with vacuum extraction (10.0% vs 1.3%; P < .001). Most vacuum extraction failures (72.6%) were followed by a trial of forceps delivery, which failed in 3.5% of cases. On multivariate logistic regression analysis, the use of forceps (vs vacuum; odds ratio [OR], 0.4; 95%CI, 0.2-0.7) and administration of analgesia (epidural: OR, 0.4 [95% CI, 0.2-0.7]; intravenous opiates: OR, 0.2 [95%CI, 0.1-0.6]) were associated with a lower risk of failure, persistent occiput posterior position (OR, 2.2; 95% CI, 1.4-3.5) and birthweight >4000 g (OR, 2.8; 95% CI, 1.6-4.9), with a higher risk.

CONCLUSION:

Fetal weight and head position should be evaluated carefully before operative vaginal delivery, and the use of analgesia should be encouraged.

PMID:
17826432
DOI:
10.1016/j.ajog.2007.06.051
[Indexed for MEDLINE]
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