Am J Obstet Gynecol.
1997 Jan;176(1 Pt
1):200-4.
Failed trial of
vacuum or
forceps--maternal
and fetal outcome.
Revah A, Ezra Y,
Farine D, Ritchie K.
Department of
Obstetrics and
Gynecology,
Mount-Sinai
Hospital, University
of Toronto, Ontario,
Canada.
Objectives:
Our
purpose was to
compare the maternal
and neonatal
morbidity associated
with a failed trial
of instrumental
delivery with that
of proceeding
directly to cesarean
section during the
second stage of
labor.
Study Design:
All second-stage
cesarean deliveries
between January 1986
and December 1992 in
a tertiary care
teaching hospital
were retrospectively
reviewed. Specific
maternal and
neonatal outcome
parameters were
studied to compare
the failed
instrumental group
with the direct-to-cesarean
section group.
Results:
Of 29,457
live births at > 37
weeks' gestation,
401 women had a
cesarean section
performed in the
second stage of
labor. There were
326 cases in which
cesarean section was
performed directly
during the second
stage of labor and
75 women who had a
failed attempt of
instrumental
delivery (forceps
33, vacuum 25, both
17) before cesarean
delivery was done.
The three
instrumental groups
and the direct-to-cesarean
section group did
not differ in any of
the outcome
variables for either
mother or newborn.
Conclusions:
Failed
instrumental
delivery performed
as a trial of
forceps and/or
vacuum in a setting
where a cesarean
section can follow
promptly is not
associated with
increased morbidity
of either mother or
baby.
