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Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station.

Abstract Increased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery.
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Mayor MeshTerms
Keywords
Journal Title cmaj : canadian medical association journal = journal de l'association medicale canadienne
Publication Year Start




PMID- 28584040
OWN - NLM
STAT- MEDLINE
DA  - 20170606
DCOM- 20170712
LR  - 20170713
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Linking)
VI  - 189
IP  - 22
DP  - 2017 Jun 05
TI  - Perinatal and maternal morbidity and mortality after attempted operative vaginal 
      delivery at midpelvic station.
PG  - E764-E772
LID - 10.1503/cmaj.161156 [doi]
AB  - BACKGROUND: Increased use of operative vaginal delivery (i.e., forceps or vacuum 
      application), of which 20% occurs at midpelvic station, has been advocated to
      reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and
      maternal morbidity and mortality associated with attempted midpelvic operative
      vaginal delivery. METHODS: We studied all term singleton deliveries in Canada
      between 2003 and 2013, by attempted midpelvic operative vaginal or cesarean
      delivery with labour (with and without prolonged second stage). The primary
      outcomes were composite severe perinatal morbidity and mortality (e.g.,
      convulsions, assisted ventilation, severe birth trauma and perinatal death), and 
      composite severe maternal morbidity and mortality (e.g., severe postpartum
      hemorrhage, shock, sepsis, cardiac complications, acute renal failure and death).
      RESULTS: The study population included 187 234 deliveries. Among women with
      dystocia and prolonged second stage of labour, midpelvic operative vaginal
      delivery was associated with higher rates of severe perinatal morbidity and
      mortality compared with cesarean delivery (forceps, adjusted odds ratio [AOR]
      1.81, 95% confidence interval [CI] 1.24 to 2.64; vacuum, AOR 1.81, 95% CI 1.17 to
      2.80; sequential instruments, AOR 3.19, 95% CI 1.73 to 5.88), especially with
      higher rates of severe birth trauma. Rates of severe maternal morbidity and
      mortality were not significantly different after operative vaginal delivery,
      although rates of obstetric trauma were higher (forceps, AOR 4.51, 95% CI 4.04 to
      5.02; vacuum, AOR 2.70, 95% CI 2.35 to 3.09; sequential instruments, AOR 4.24,
      95% CI 3.46 to 5.19). Among women with fetal distress, similar associations were 
      seen for severe birth trauma and obstetric trauma, although vacuum was associated
      with lower rates of severe maternal morbidity and mortality (AOR 0.52, 95% CI
      0.33 to 0.80). Associations tended to be stronger among women without a prolonged
      second stage. INTERPRETATION: Midpelvic operative vaginal delivery is associated 
      with higher rates of severe birth trauma and obstetric trauma, whereas overall
      rates of severe perinatal and maternal morbidity and mortality vary by indication
      and operative instrument.
CI  - (c) 2017 Canadian Medical Association or its licensors.
FAU - Muraca, Giulia M
AU  - Muraca GM
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia [email protected]
FAU - Sabr, Yasser
AU  - Sabr Y
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
FAU - Lisonkova, Sarka
AU  - Lisonkova S
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
FAU - Skoll, Amanda
AU  - Skoll A
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
FAU - Brant, Rollin
AU  - Brant R
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
FAU - Cundiff, Geoffrey W
AU  - Cundiff GW
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
FAU - Joseph, K S
AU  - Joseph KS
AD  - School of Population and Public Health (Muraca, Lisonkova, Joseph); Department of
      Obstetrics & Gynaecology (Muraca, Sabr, Lisonkova, Skoll, Cundiff, Joseph);
      Department of Statistics (Brant), The University of British Columbia, Vancouver, 
      BC; Department of Obstetrics and Gynaecology (Sabr), King Saud University,
      Riyadh, Saudi Arabia.
LA  - eng
PT  - Journal Article
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale
      canadienne
JID - 9711805
SB  - AIM
SB  - IM
MH  - Adult
MH  - Birth Injuries/*epidemiology
MH  - Canada
MH  - Cesarean Section/*adverse effects
MH  - Databases, Factual
MH  - Dystocia/*epidemiology
MH  - Female
MH  - Humans
MH  - Infant, Newborn
MH  - Logistic Models
MH  - Maternal Mortality
MH  - Multivariate Analysis
MH  - Obstetric Labor Complications/*epidemiology
MH  - Obstetrical Forceps/*adverse effects
MH  - Odds Ratio
MH  - Perinatal Mortality
MH  - Postpartum Hemorrhage/*epidemiology
MH  - Pregnancy
MH  - Young Adult
PMC - PMC5461125
COI - Competing interests: None declared.
EDAT- 2017/06/07 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/06/07 06:00
PHST- 2017/01/31 [accepted]
AID - 189/22/E764 [pii]
AID - 10.1503/cmaj.161156 [doi]
PST - ppublish
SO  - CMAJ. 2017 Jun 5;189(22):E764-E772. doi: 10.1503/cmaj.161156.