Prapas N1, Kalogiannidis I1, Diamanti E2, Karagiannidou E1, Papanikolaou A1, Makedos A1, Drossou- Agakidou V2, Makedos G1
14th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokrateio hospital, Thessaloniki, Greece,
21st Department of Neonatology and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Hippokrateio hospital, Thessaloniki, Greece
Correspondence: Prapas Nikolaos 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokrateio hospital, 49 Konstantinoupoleos St, GR-54642, Thessaloniki, Greece. E-mail: firstname.lastname@example.org
The purpose of our study was to estimate the differences in maternal and neonatal outcomes in singleton term pregnancies delivered using forceps or vacuum. We retrospectively studied the instrumental vaginal deliveries that occurred from January 2000 to June 2004 in the 4th Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki. Multiple gestations, stillbirths and neonates with birth weights <2,500g or >4,000g were excluded from the study. Characteristics of pregnancies, indications of operative deliveries and maternal outcomes such as perineal lacerations and postpartum bleeding were estimated. Neonatal outcomes including Apgar score, need for mechanical ventilation in the delivery room, incidence of birth injuries, respiratory and neurological complications were assessed. Out of 259 instrumental deliveries, 216 (83.5%) were vacuum assisted (Group A) and 43 (16.5%) were forceps assisted (Group B). Prolonged second stage of labor and non-reassuring fetal heart rate were the most often indications for assisted delivery for both groups. Second and third degree of perineal lacerations were more often in group B (6.9% and 4.6%, respectively) as compared with group A (4.2% and 3.4%) (p<0.05). In group B, the Apgar score at 1 min was significantly lower and the duration of hospitalization in the NICU was significantly higher. Also, there was a trend toward an increased incidence of respiratory distress and admission to the NICU in group B. No significant difference was observed regarding the incidence of cephalematoma whereas no neonate had evidence of hypoxic-ischaemic encephalopathy or intracerebral hemorrhage. In conclusion, maternal morbidity with regard to perineal lacerations was increased in forceps delivery compared with the vacuum assisted delivery although not significantly. In addition, neonatal outcome did not differ significantly between the two groups.
Keywords: instrumental delivery, operative delivery, vacuum, forceps assisted delivery, neonatal morbidity