Outcome of maternal and neonatal effects of forceps and vacuum assisted deliveries

Abstract

INTRODUCTION: Forceps and vacuum are instruments designed to aid in the delivery of the fetus by applying traction on fetal head. The use of vacuum extraction in relation to forceps has increased in other countries. The aim of this study was to compare the risk of maternal and neonatal adverse outcomes between forceps and vacuum assisted deliveries. METHOD AND MATERIALS: This was a descriptive study of 70 singleton operative vaginal deliveries at the University Obstetric Unit, Colombo North Teaching Hospital from 1 st of January 201 0 to 7th of June 201 0. Maternal outcome, such as perineal tears and presence of lacerations, were studied. Neonatal outcome was evaluated with Apgar scores, admissions to neonatal intensive care unit, cephalhaematomas, bruising and instrument marks. RESULTS: Among 70 operative vaginal deliveries, 56 were forceps (80%), 14 were vacuum deliveries (20%). The mean age was 30. 5 years (range 23 -36). Forty two women out of seventy were primigravidae. The mean birth weight of babies delivered by forceps was 321 6g (range 2450 - 4200g) and by vacuum was 3260g (range 2280 - 3680g). There were five instances where vacuum was followed by forceps deliveries. The indications for instrumental deliveries were prolonged second stage 47 (68%), maternal exhaustion 8 (12%), valvular heart disease 6 (8%) and medical problems 9 (10%). Forceps were used more often than vacuum for prolonged second stage of labour (38 Vs 9). There were a higher rate of maternal third- and fourth-degree perineal (12 Vs 4) and vaginal lacerations (28 Vs 7) with the use of forceps. There were no perinatal deaths in either group. There were eight (5.6%) admissions to special care baby unit and receipt of assisted ventilation. More instrument marks and bruising (11 Vs 0) were also found in the neonates delivered by forceps, whereas there was a greater incidence of cephalhematomas (8 Vs 1) in the neonates delivered with vacuum.