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Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery
Author(s) -
Muraca GM,
Skoll A,
Lisonkova S,
Sabr Y,
Brant R,
Cundiff GW,
Joseph KS
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14820
Subject(s) - medicine , vaginal delivery , obstetrics , relative risk , population , fetal distress , confidence interval , pregnancy , fetus , genetics , environmental health , biology
Objective To quantify severe perinatal and maternal morbidity/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery. Design Population‐based, retrospective cohort study. Setting British Columbia, Canada. Population Term, singleton deliveries (2004–2014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery ( n = 10 901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress). Methods Multinomial propensity scores and mulitvariable log‐binomial regression models were used to estimate adjusted rate ratios ( ARR ) and 95% confidence intervals (95% CI ). Main outcome measures Composite severe perinatal morbidity/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications). Results Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity/mortality compared with caesarean delivery (forceps ARR 2.11, 95% CI 1.46–3.07; vacuum ARR 2.71, 95% CI 1.49–3.15; sequential ARR 4.68, 95% CI 3.33–6.58). Rates of severe maternal morbidity/mortality were also higher following midcavity operative vaginal delivery (forceps ARR 1.57, 95% CI 1.05–2.36; vacuum ARR 2.29, 95% CI 1.57–3.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity/mortality following attempted midcavity vacuum ( ARR 1.28, 95% CI 1.04–1.61) and in severe maternal morbidity following attempted midcavity forceps delivery ( ARR 2.34, 95% CI 1.54–3.56). Conclusion Attempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity/mortality and severe maternal morbidity, though these effects differ by indication and instrument. Tweetable abstract Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery.