Observational Study

. 2020 Apr;37(5):503-510.

doi: 10.1055/s-0039-1683439. Epub 2019 Mar 20.

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Emily S Miller¹, Yinglei Lai², Jennifer Bailit³, Uma M Reddy, Ronald J Wapner⁴, Michael W Varner⁵, John M Thorp Jr⁶, Kenneth J Leveno⁷, Steve N Caritis⁸, Mona Prasad⁹, Alan T N Tita¹⁰, George R Saade¹¹, Yoram Sorokin¹², Dwight J Rouse¹³, Sean C Blackwell¹⁴, Jorge E Tolosa¹⁵; Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network*

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network*:
W Grobman¹⁶, G Mallett¹⁶, M Ramos-Brinson¹⁶, A Roy¹⁶, L Stein¹⁶, P Campbell¹⁶, C Collins¹⁶, N Jackson¹⁶, M Dinsmoor¹⁶, J Senka¹⁷, K Paychek¹⁷, A Peaceman¹⁷, M Talucci¹⁸, M Zylfijaj¹⁸, Z Reid¹⁸, R Leed¹⁹, J Benson¹⁹, S Forester²⁰, C Kitto²⁰, S Davis²⁰, M Falk²¹, C Perez²¹, K Hill²², A Sowles²², J Postma²², S Alexander²³, G Andersen²³, V Scott²³, V Morby²⁴, K Jolley²⁴, J Miller²⁵, B Berg²⁵, K Dorman²⁶, J Mitchell²⁶, E Kaluta²⁶, K Clark²⁶, K Spicer²⁷, S Timlin²⁷, K Wilson²⁸, L Moseley²⁹, M Santillan²⁹, J Price²⁹, K Buentipo²⁹, V Bludau²⁹, T Thomas²⁹, L Fay²⁹, C Melton²⁹, J Kingsbery²⁹, R Benezue²⁹, H Simhan³⁰, M Bickus³⁰, D Fischer³⁰, T Kamon³⁰, D DeAngelis³¹, B Mercer³², C Milluzzi³², W Dalton³², T Dotson³², P McDonald³², C Brezine³², A McGrail³², C Latimer³³, L Guzzo³³, F Johnson³⁴, L Gerwig³⁴, S Fyffe³⁴, D Loux³⁴, S Frantz³⁴, D Cline³⁴, S Wylie³⁴, J Iams³⁴, M Wallace³⁵, A Northen³⁵, J Grant³⁵, C Colquitt³⁵, D Rouse³⁵, W Andrews³⁵, J Moss³⁶, A Salazar³⁶, A Acosta³⁶, G Hankins³⁶, N Hauff³⁷, L Palmer³⁷, P Lockhart³⁷, D Driscoll³⁷, L Wynn³⁷, C Sudz³⁷, D Dengate³⁷, C Girard³⁷, S Field³⁷, P Breault³⁸, F Smith³⁸, N Annunziata³⁸, D Allard³⁸, J Silva³⁸, M Gamage³⁸, J Hunt³⁸, J Tillinghast³⁸, N Corcoran³⁸, M Jimenez³⁸, F Ortiz³⁹, P Givens³⁹, B Rech³⁹, C Moran³⁹, M Hutchinson³⁹, Z Spears³⁹, C Carreno³⁹, B Heaps³⁹, G Zamora³⁹, J Seguin⁴⁰, M Rincon⁴⁰, J Snyder⁴⁰, C Farrar⁴⁰, E Lairson⁴⁰, C Bonino⁴⁰, W Smith⁴⁰, K Beach⁴¹, S Van Dyke⁴¹, S Butcher⁴¹, E Thom⁴², M Rice⁴², Y Zhao⁴², P McGee⁴², V Momirova⁴², R Palugod⁴², B Reamer⁴², M Larsen⁴², C Spong⁴³, S Tolivaisa⁴³, J P VanDorsten⁴⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
² Biostatistics Center, The George Washington University, Washington, District of Columbia.
³ Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
⁴ Department of Obstetrics and Gynecology, Columbia University, New York, New York.
⁵ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁶ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁷ Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas.
⁸ Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁹ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
¹⁰ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
¹¹ Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
¹² Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
¹³ Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
¹⁴ Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
¹⁵ Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
¹⁶ Northwestern University, Chicago, IL.
¹⁷ (NorthShore University HealthSystem).
¹⁸ Columbia University, New York, NY.
¹⁹ (Drexel U.).
²⁰ (Christiana H.).
²¹ (St. Peter's UH.).
²² University of Utah Health Sciences Center, Salt Lake City, UT.
²³ (LDS Hospital).
²⁴ (McKay-Dee).
²⁵ (UVRMC).
²⁶ University of North Carolina at Chapel Hill, Chapel Hill, NC.
²⁷ (WakeMed).
²⁸ (Rex).
²⁹ University of Texas Southwestern Medical Center, Dallas, TX.
³⁰ University of Pittsburgh, Pittsburgh, PA.
³¹ (deceased).
³² MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
³³ The Ohio State University, Columbus, OH.
³⁴ (St. Ann's).
³⁵ University of Alabama at Birmingham, Birmingham, AL.
³⁶ The University of Texas Medical Branch, Galveston, TX.
³⁷ Wayne State University, Detroit, MI.
³⁸ Brown University, Providence, RI.
³⁹ Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX.
⁴⁰ Oregon Health & Science University, Portland, OR.
⁴¹ (Kaiser Permanente).
⁴² Biostatistics Center, The George Washington University, Washington, DC.
⁴³ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴⁴ MFMU Network Steering Committee Chair (Medical University of South Carolina, Charleston, SC).

PMID: 30895577
PMCID: PMC6754310
DOI: 10.1055/s-0039-1683439

Observational Study

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Emily S Miller et al. Am J Perinatol. 2020 Apr.

. 2020 Apr;37(5):503-510.

doi: 10.1055/s-0039-1683439. Epub 2019 Mar 20.

Authors

Collaborators

Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network*:
W Grobman¹⁶, G Mallett¹⁶, M Ramos-Brinson¹⁶, A Roy¹⁶, L Stein¹⁶, P Campbell¹⁶, C Collins¹⁶, N Jackson¹⁶, M Dinsmoor¹⁶, J Senka¹⁷, K Paychek¹⁷, A Peaceman¹⁷, M Talucci¹⁸, M Zylfijaj¹⁸, Z Reid¹⁸, R Leed¹⁹, J Benson¹⁹, S Forester²⁰, C Kitto²⁰, S Davis²⁰, M Falk²¹, C Perez²¹, K Hill²², A Sowles²², J Postma²², S Alexander²³, G Andersen²³, V Scott²³, V Morby²⁴, K Jolley²⁴, J Miller²⁵, B Berg²⁵, K Dorman²⁶, J Mitchell²⁶, E Kaluta²⁶, K Clark²⁶, K Spicer²⁷, S Timlin²⁷, K Wilson²⁸, L Moseley²⁹, M Santillan²⁹, J Price²⁹, K Buentipo²⁹, V Bludau²⁹, T Thomas²⁹, L Fay²⁹, C Melton²⁹, J Kingsbery²⁹, R Benezue²⁹, H Simhan³⁰, M Bickus³⁰, D Fischer³⁰, T Kamon³⁰, D DeAngelis³¹, B Mercer³², C Milluzzi³², W Dalton³², T Dotson³², P McDonald³², C Brezine³², A McGrail³², C Latimer³³, L Guzzo³³, F Johnson³⁴, L Gerwig³⁴, S Fyffe³⁴, D Loux³⁴, S Frantz³⁴, D Cline³⁴, S Wylie³⁴, J Iams³⁴, M Wallace³⁵, A Northen³⁵, J Grant³⁵, C Colquitt³⁵, D Rouse³⁵, W Andrews³⁵, J Moss³⁶, A Salazar³⁶, A Acosta³⁶, G Hankins³⁶, N Hauff³⁷, L Palmer³⁷, P Lockhart³⁷, D Driscoll³⁷, L Wynn³⁷, C Sudz³⁷, D Dengate³⁷, C Girard³⁷, S Field³⁷, P Breault³⁸, F Smith³⁸, N Annunziata³⁸, D Allard³⁸, J Silva³⁸, M Gamage³⁸, J Hunt³⁸, J Tillinghast³⁸, N Corcoran³⁸, M Jimenez³⁸, F Ortiz³⁹, P Givens³⁹, B Rech³⁹, C Moran³⁹, M Hutchinson³⁹, Z Spears³⁹, C Carreno³⁹, B Heaps³⁹, G Zamora³⁹, J Seguin⁴⁰, M Rincon⁴⁰, J Snyder⁴⁰, C Farrar⁴⁰, E Lairson⁴⁰, C Bonino⁴⁰, W Smith⁴⁰, K Beach⁴¹, S Van Dyke⁴¹, S Butcher⁴¹, E Thom⁴², M Rice⁴², Y Zhao⁴², P McGee⁴², V Momirova⁴², R Palugod⁴², B Reamer⁴², M Larsen⁴², C Spong⁴³, S Tolivaisa⁴³, J P VanDorsten⁴⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
² Biostatistics Center, The George Washington University, Washington, District of Columbia.
³ Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
⁴ Department of Obstetrics and Gynecology, Columbia University, New York, New York.
⁵ Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah.
⁶ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
⁷ Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas.
⁸ Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁹ Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
¹⁰ Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
¹¹ Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas.
¹² Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
¹³ Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
¹⁴ Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas.
¹⁵ Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.
¹⁶ Northwestern University, Chicago, IL.
¹⁷ (NorthShore University HealthSystem).
¹⁸ Columbia University, New York, NY.
¹⁹ (Drexel U.).
²⁰ (Christiana H.).
²¹ (St. Peter's UH.).
²² University of Utah Health Sciences Center, Salt Lake City, UT.
²³ (LDS Hospital).
²⁴ (McKay-Dee).
²⁵ (UVRMC).
²⁶ University of North Carolina at Chapel Hill, Chapel Hill, NC.
²⁷ (WakeMed).
²⁸ (Rex).
²⁹ University of Texas Southwestern Medical Center, Dallas, TX.
³⁰ University of Pittsburgh, Pittsburgh, PA.
³¹ (deceased).
³² MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
³³ The Ohio State University, Columbus, OH.
³⁴ (St. Ann's).
³⁵ University of Alabama at Birmingham, Birmingham, AL.
³⁶ The University of Texas Medical Branch, Galveston, TX.
³⁷ Wayne State University, Detroit, MI.
³⁸ Brown University, Providence, RI.
³⁹ Children's Memorial Hermann Hospital, The University of Texas Health Science Center at Houston, Houston, TX.
⁴⁰ Oregon Health & Science University, Portland, OR.
⁴¹ (Kaiser Permanente).
⁴² Biostatistics Center, The George Washington University, Washington, DC.
⁴³ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
⁴⁴ MFMU Network Steering Committee Chair (Medical University of South Carolina, Charleston, SC).

PMID: 30895577
PMCID: PMC6754310
DOI: 10.1055/s-0039-1683439

Abstract

Objective: This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes.

Study design: This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls.

Results: Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application.

Conclusion: The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

**Fig. 1**
Flow chart of women eligible for analyses.

See this image and copyright information in PMC

References

1. Operative vaginal delivery. ACOG Technical Bulletin Number 196-August 1994 (replaces No. 152, February 1991). Int J Gynaecol Obstet 1994;47(02):179–185 - PubMed
1. Bofill JA, Rust OA, Devidas M, Roberts WE, Morrison JC, Martin JN Jr. Neonatal cephalohematoma from vacuum extraction. J Reprod Med 1997;42(09):565–569 - PubMed
1. Bofill JA, Rust OA, Schorr SJ, Brown RC, Roberts WE, Morrison JC. A randomized trial of two vacuum extraction techniques. Obstet Gynecol 1997;89(5 Pt 1):758–762 - PubMed
1. Murphy DJ, Liebling RE, Patel R, Verity L, Swingler R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG 2003;110(06):610–615 - PubMed
1. Grobman WA, Bailit JL, Rice MM, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study. Am J Obstet Gynecol 2014;211 (02):147.e1–147.e16 - PMC - PubMed

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Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Collaborators

Affiliations

Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical