Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 125; no. 6; pp. 693 - 702
• Main Authors: Muraca, GM, Skoll, A, Lisonkova, S, Sabr, Y, Brant, R, Cundiff, GW, Joseph, KS
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2018; John Wiley and Sons Inc
• Subjects: Adult; Birth injuries; Birth Injuries - mortality; Birth injury; British Columbia - epidemiology; caesarean delivery; Cesarean section; Cesarean Section - adverse effects; Childbirth & labor; Convulsions; Delivery, Obstetric - adverse effects; Dystocia - mortality; Electrocardiography; Female; Fetal Distress - mortality; Fetuses; forceps extraction; General Obstetrics; Health risk assessment; Heart diseases; Hemorrhage; Humans; Infant, Newborn; instrumental vaginal delivery; Maternal Mortality; Morbidity; Mortality; Obstetric Labor Complications - mortality; obstetric trauma; Obstetrical Forceps - adverse effects; operative vaginal delivery; Perinatal Mortality; Population studies; Postpartum; Pregnancy; Regression analysis; Retrospective Studies; Sepsis; Term Birth; Trauma; Vacuum; vacuum extraction; Vagina; Young Adult; British Columbia; Canada; forceps extraction; obstetric trauma; vacuum extraction; operative vaginal delivery; Birth injury; caesarean delivery; instrumental vaginal delivery
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.14820

Objective To quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery. Design Population‐based, retrospective cohort study. Setting British Columbia, Canada. Population Term, singleton deliveries (2004–2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress). Methods Multinomial propensity scores and mulitvariable log‐binomial regression models were used to estimate adjusted rate ratios (ARR) and 95% confidence intervals (95% CI). Main outcome measures Composite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications). Results Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46–3.07; vacuum ARR 2.71, 95% CI 1.49–3.15; sequential ARR 4.68, 95% CI 3.33–6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05–2.36; vacuum ARR 2.29, 95% CI 1.57–3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum (ARR 1.28, 95% CI 1.04–1.61) and in severe maternal morbidity following attempted midcavity forceps delivery (ARR 2.34, 95% CI 1.54–3.56). Conclusion Attempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument. Tweetable Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery. Tweetable Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery.