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Operative vaginal delivery

Authors
Elisabeth K Wegner, MD
Ira M Bernstein, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Operative vaginal delivery refers to a delivery in which the operator uses forceps or a vacuum device to extract the fetus from the vagina, with or without the assistance of maternal pushing. The decision to use an instrument to deliver the fetus balances the maternal, fetal, and neonatal impact of the procedure against the alternative options of cesarean birth or expectant management.

This topic will discuss issues related to operative vaginal delivery. The technique for vacuum assisted operative delivery is reviewed separately. (See "Procedure for vacuum-assisted operative vaginal delivery".)

PREVALENCE

In the United States, 3.1 percent of all deliveries in 2015 were accomplished via an operative vaginal approach [1]. Forceps deliveries accounted for 0.56 percent of vaginal births and vacuum deliveries accounted for 2.58 percent of vaginal births. However, there is a wide range in the prevalence of operative vaginal delivery both across and within geographic regions in the United States (1 to 23 percent) which suggests that evidence-based guidelines for operative vaginal delivery are either inadequate or randomly applied, or familiarity and expertise with the technique is declining [2].

INDICATIONS

Overview — Use of forceps or vacuum is reasonable when an operative intervention to terminate labor is indicated and operative vaginal delivery can be safely and readily accomplished; otherwise, cesarean delivery is the better option.

We agree with an American College of Obstetricians and Gynecologists (ACOG) practice bulletin that considers "prolonged second stage of labor, suspicion of immediate or potential fetal compromise, and shortening the second stage for maternal benefit" appropriate indications for operative vaginal delivery (forceps or vacuum) [3]. However, no indication is absolute, and cesarean delivery is also an option in these clinical settings.

                                     

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Literature review current through: Mar 2017. | This topic last updated: Mar 31, 2017.
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