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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-. doi: 10.1002/14651858.CD005545.pub3

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet].

Trial of instrumental birth in theatre versus immediate caesarean section for anticipated difficult assisted births

This version published: 2012; Review content assessed as up-to-date: August 07, 2012.

Plain language summary

Most women give birth spontaneously, but some need assistance during the second stage of labour with obstetric forceps or the vacuum. The rates of instrumental vaginal births range from 5% to 20% of all births in high‐income countries, with little information about the incidence in low‐income countries. Indications for instrumental vaginal births are generally fetal heart rate abnormalities, poor position of the baby, maternal exhaustion and some maternal medical conditions such as heart disease. The majority of instrumental vaginal births are conducted in the delivery room, but in a small proportion of anticipated difficult births (2% to 5%), a trial of instrumental vaginal birth is conducted in theatre with preparations made for proceeding to caesarean section. It has been suggested that for these anticipated difficult assisted vaginal births, it may be preferable to go straight to caesarean section. The advantage of doing an immediate caesarean section would be a reduced risk of morbidity for both mother and baby from a failed attempted instrumental birth. However, the disadvantages of routinely doing a caesarean section in these circumstances are an increased risk of morbidity from caesarean section which often manifests itself at a subsequent birth. The review of trials looking at attempted instrumental delivery in theatre versus immediate caesarean section for anticipated difficult births identified no trials to help with making this decision. Further research is clearly needed.

Abstract

Background: The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section.

Objectives: To determine differences in maternal and neonatal morbidity between women who, due to anticipated difficulty, have trial of instrumental vaginal delivery in theatre and those who have immediate caesarean section for failure to progress in the second stage.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 June 2012).

Selection criteria: Randomised controlled trials comparing trial of instrumental vaginal delivery (vacuum extraction or forceps) in operating theatre to immediate caesarean section for women with failure to progress in the second stage (active second stage more than 60 minutes in primigravidae).

Data collection and analysis: We identified no studies meeting our inclusion criteria.

Main results: No studies were included.

Authors' conclusions: There is no current evidence from randomised trials to influence practice.

Editorial Group: Cochrane Pregnancy and Childbirth Group.

Publication status: New search for studies and content updated (no change to conclusions).

Citation: Majoko F, Gardener G. Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD005545. DOI: 10.1002/14651858.CD005545.pub3. Link to Cochrane Library. [PMC free article: PMC4171385] [PubMed: 23076915]

Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

PMID: 23076915

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