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Operative vaginal delivery

INTRODUCTION

Operative vaginal delivery refers to a delivery in which the operator uses forceps or a vacuum device to assist the mother in transitioning the fetus to extrauterine life. The instrument is applied to the fetal head and then the operator uses traction to extract the fetus, typically during a contraction while the mother is pushing.

The first instrumental deliveries were performed to extract fetuses from parturients who were at high risk of maternal mortality due to prolonged and/or obstructed labor. In these cases, saving the mother's life took precedence over possible harm to the fetus. The focus of these procedures has changed as a result of modern obstetrical practices that have drastically reduced the risk of intrapartum maternal mortality and major morbidity. Decisions regarding use of instrumental delivery are now based primarily upon the fetal/neonatal impact of these procedures and are weighed against the alternative options of cesarean birth, expectant management (prolonging the second stage), and augmentation of contractions with oxytocin.

INCIDENCE

In the United States, 3.5 percent of all deliveries are accomplished via an operative vaginal approach [1]. The overall rate of operative vaginal delivery has been diminishing, but the proportion of operative vaginal deliveries conducted by vacuum assisted births has been increasing and is more than four times the rate of forceps assisted births. Forceps deliveries account for 1 percent of vaginal births and vacuum deliveries account for about 4 percent of vaginal births.

In recent years, the success rate for operative vaginal deliveries has been quite high (99 percent) [2]. This likely reflects appropriate choice of candidates for this intervention. However, the wide range of operative vaginal delivery rates (1 to 23 percent), both across and within geographic regions in the United States, suggests that evidence based guidelines for operative vaginal delivery are either inadequate or randomly applied [3].

INDICATIONS

An American College of Obstetricians and Gynecologists (ACOG) practice bulletin outlined the following indications for operative vaginal delivery (forceps or vacuum), recognizing that no indication is absolute; cesarean delivery is also an option in these clinical settings [4]:

                               

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Literature review current through: Nov 2014. | This topic last updated: Dec 2, 2014.
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