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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Number 05

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Ginecol Obstet Mex 2021; 89 (05)

Forceps versus vacuum. Comparison of maternal and fetal success rates and complications

Moreno-Santillán A, González-Barreto RA

Language: Spanish
References: 16
Page: 357-363
PDF size: 195.70 Kb.


ABSTRACT

Objetivo: To compare the rate of success and maternal and fetal complications related to the application of vacuum extractor versus forceps in instrumental delivery assistance.
Materials and Methods: Retrospective, observational and comparative study in patients with singleton term pregnancy in whom delivery was instrumented with vacuum extractor or forceps. Indications, technical parameters, maternal and fetal complications, and success of the application of the study groups were recorded. Statistical analysis was performed with χ2 and Student's t test.
Results: Instrumentation during labor was applied to 128 patients, of which 38 were forceps and 90 vacuum. The success rate for forceps was 100% and for vacuum 92.2% (p = 0.8). The outcomes vacuum vs. forceps were Apgar at 1 minute and 5 minutes (8.16 vs. 7.6; p = 0.001 and 8.9 vs. 8.7; p = 0.01) for vacuum, higher immediate attachment (91. 1 vs 15.7%; p ‹ 0.05) and joint accommodation (77.7 vs 50.5%; p ‹ 0.05), fewer minor injuries (23 vs 57%; p ‹ 0.05) and severe injuries (1.1 vs 23.6%; p ‹ 0.05).
Conclusions: The success of forceps and vacuum assisted delivery is similar; with the former, significantly lower Apgar scores and higher maternal and fetal complications were associated. These outcomes can be explained in different contexts; the fact that vacuum is used more often than forceps may be due to the fact that the learning curve for vacuum extractor is shorter, in addition to the fact that it is more accepted by the health care team and the patient.


REFERENCES

  1. Singh S, Munikrishna M, Sheela S. A comparative study of maternal outcome between vacuum extraction and outlet forceps delivery. Int J Reprod Contracept Obstet Gynecol. 2018; 7 (6): 2441-45. http://dx.doi.org/10.18203/2320- 1770.ijrcog20182365.

  2. Cuevas P, Carvajal J. El uso de vacuum extractor disminuye la tasa de lesiones maternas severas asociadas al fórceps sin aumentar las complicaciones fetales severas. Rev Chil Obstet Ginecol. 2007; 72 (5): 329-33. http://dx.doi. org/10.4067/S0717-75262007000500009.

  3. Sainz JA, García-Mejido JA, Aquise A, Borrero C, Bonomi MJ, Fernandez A. A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps. Am J Obstet Gynecol. 2018; 220 (2): 193.e1-193.e12. https:// doi.org/10.1016/j.ajog.2018.10.035.

  4. Hernández-Hernández D, Ramírez ML, Pichardo M, Moreno JA, Jaimes M, Contreras N. Complicaciones maternas y neonatales secundarias a parto vaginal instrumentado con fórceps. Rev Invest Med Sur Mex. 2012; 19 (2): 52-55.

  5. O’Mahony F, Hofmeyr GJ, Menon V. Choice of instruments for assisted vaginal delivery. Cochrane Database of Systematic Reviews, 2010, Issue 11. Art. No.: CD005455. doi: 10.1002/14651858.CD005455.pub2.

  6. Levin G, Elchalal U, Yagel S, Eventov-Friedman S, Ezra Y, Sompolinsky Y, et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand. 2019; 98 (11): 1464-72. https:// doi.org/10.1111/aogs.13678.

  7. Krizman E, Grzebielski P, Antony KM, Sampene E, Shanahan M, Iruretagoyena JI, et al. Operative Vaginal Delivery Is a Safe Option in Women Undergoing a Trial of Labor after Cesarean. American Journal of Perinatology Reports, 2019; 9 (2): e190-e194. doi: 10.1055/s-0039-1692482.

  8. Jeon J, Na S. Vacuum extraction vaginal delivery: current trend and safety. Obstet Gynecol Sci, 2017; 60 (6): 499-505. 10.5468/ogs.2017.60.6.499.

  9. Seki H. Complications with vacuum delivery from a forcepsdelivery perspective: Progress toward safe vacuum delivery. J Obstet Gynaecol Res. 2018; 44 (8): 1347-54. https:// doi.org/10.1111/jog.13685.

  10. Sainz JA, Garcia-Mejido JA, Aquise A, Bonomi MJ, Borrero C, De La Fuente P, et al. Intrapartum transperineal ultrasound used to predict cases of complicated operative (vacuum and forceps) deliveries in nulliparous women. Acta Obstet Gynecol Scand. 2017; 96: 1490-97. https:// doi.org/10.1111/aogs.13230.

  11. Skinner S, Davies-Tuck M, Wallace E, Hodges R. Perinatal and maternal outcomes after training residents in forceps before vacuum instrumental birth. Obstet Gynecol. 2017; 130 (1): 151-58. doi: 10.1097/AOG.0000000000002097.

  12. Bailit JL, Grobman WA, Rice MM, Wapner R, Reddy UM, Varner M, et al. Evaluation of delivery options for secondstage events. Am J Obstet Gynecol. 2016; 214: 638.e1-10. https://doi.org/10.1016/j.ajog.2015.11.007.

  13. Lund NS, Persson L, Jangö H, Gommesen D, Westergaard HB. Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016; 207: 193-99. doi: 10.1016/j.ejogrb.2016.10.013.

  14. Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal delivery. Cochrane Database of Systematic Reviews, 2017, Issue 8. Art. No.: CD004455. DOI: 10.1002/14651858. CD004455.pub4.

  15. Mohamed-Ahmed O, Hinshaw K, Knight M. Operative vaginal delivery and post-partum infection. Best Pract Res Clin Obstet Gynaecol. 2019; 56: 93-106. https://doi. org/10.1016/j.bpobgyn.2018.09.005.

  16. Knight M, Chiocchia V, Partlett C, Rivero-Arias O, Hua X, Bowler U, et al. Intravenous co-amoxiclav to prevent infection after operative vaginal delivery: the ANODE RCT. Health Technol Assess 2019; 23 (54). https://doi. org/10.3310/hta23540




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