For a study, researchers sought to measure severe short-term maternal and newborn morbidity, as well as pelvic floor problems, at 6 months postpartum following attempted surgical vaginal delivery using the equipment utilized. A prospective study of women with live, singleton, term fetuses with vertex presentation was carried out. From December 2008 to October 2013, patients tried surgical vaginal birth at a French tertiary care university hospital. To adjust for indication bias and compare outcomes associated with vacuum-assisted, forceps-, or spatula-assisted delivery, they employed multivariable logistic regression and propensity score approaches. The composite primary objectives were severe maternal and neonatal morbidity. Validated self-administered questionnaires were used to measure symptoms of urine incontinence (UI) and anal incontinence (AI) 6 months after birth.
Among the 2,128 operational vaginal births attempted, 30.7% (n=654) employed a vacuum and 69.3% (n=1,474) used forceps or spatulas. Severe maternal morbidity occurred in 5.4 percent (n=35; 95% CI 3.8–7.4) of vacuum attempts and 10.5% (n=154; 95% CI 8.3–12.1) of forceps or spatula attempts (P<.001); severe neonatal morbidity occurred in 8.4% (n=55; 95% CI 6.4–10.8) of vacuum attempts and 10.2% (n=155; 95% CI 8.7–11.8) of forceps Although attempted operative vaginal deliveries with forceps or spatula were significantly associated with more frequent severe maternal morbidity in the multivariable logistic regression analysis (aOR 1.99 95% CI 1.27–3.10), this association was no longer significant after propensity score matching (aOR 1.46 95% CI 0.72–2.95). After multivariable logistic regression or propensity score matching, attempted surgical vaginal births using forceps or spatula were not linked with a higher frequency of severe newborn morbidity. The prevalence of UI and AI symptoms was 22.7% and 22.0%, respectively, among the 934 women (43.9%) who replied to questionnaires at 6 months, with no significant differences between the groups.
Following correcting for indication bias using a propensity score analysis, neither severe short-term maternal or newborn morbidity, nor UI or AI, were more common after attempted surgical vaginal delivery by forceps or spatulas than by vacuum in singleton term pregnancies.
