TY - JOUR
T1 - Failed operative vaginal delivery
AU - Alexander, James M.
AU - Leveno, Kenneth J.
AU - Hauth, John C.
AU - Landon, Mark B.
AU - Gilbert, Sharon
AU - Spong, Catherine Y.
AU - Varner, Michael W.
AU - Caritis, Steve N.
AU - Meis, Paul
AU - Wapner, Ronald J.
AU - Sorokin, Yoram
AU - Miodovnik, Menachem
AU - O'Sullivan, Mary J.
AU - Sibai, Baha M.
AU - Langer, Oded
AU - Gabbe, Steven G.
PY - 2009/11
Y1 - 2009/11
N2 - OBJECTIVE: To compare maternal and neonatal outcomes in women undergoing second-stage cesarean delivery after a trial of operative vaginal delivery with those in women undergoing second-stage cesarean delivery without such an attempt. METHODS: This study is a secondary analysis of the women who underwent second-stage cesarean delivery. The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Neonatal outcomes examined included umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy, stillbirth, skull fracture, and neonatal death. RESULTS: Of 3,189 women who underwent secondstage cesarean delivery, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups, with the exception of the admission-todelivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a nonreassuring fetal heart rate tracing (18.0% compared with 13.9%, P=.01), have a wound complication (2.7% compared with 1.0%, odds ratio [OR] 2.65, 95% confidence interval [Cl] 1.43-4.91), and require general anesthesia (8.0% compared with 4.1%, OR 2.05, 95% Cl 1.44-2.91). Neonatal outcomes, including umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, and hypoxic ischemic encephalopathy, were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a nonreassuring fetal heart rate tracing were removed. CONCLUSION: Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a nonreassuring fetal heart rate tracing.
AB - OBJECTIVE: To compare maternal and neonatal outcomes in women undergoing second-stage cesarean delivery after a trial of operative vaginal delivery with those in women undergoing second-stage cesarean delivery without such an attempt. METHODS: This study is a secondary analysis of the women who underwent second-stage cesarean delivery. The maternal outcomes examined included blood transfusion, endometritis, wound complication, anesthesia use, and maternal death. Neonatal outcomes examined included umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, seizures within 24 hours of birth, hypoxic ischemic encephalopathy, stillbirth, skull fracture, and neonatal death. RESULTS: Of 3,189 women who underwent secondstage cesarean delivery, operative vaginal delivery was attempted in 640. Labor characteristics were similar in the two groups, with the exception of the admission-todelivery time and cesarean indication. Those with an attempted operative vaginal delivery were more likely to undergo cesarean delivery for a nonreassuring fetal heart rate tracing (18.0% compared with 13.9%, P=.01), have a wound complication (2.7% compared with 1.0%, odds ratio [OR] 2.65, 95% confidence interval [Cl] 1.43-4.91), and require general anesthesia (8.0% compared with 4.1%, OR 2.05, 95% Cl 1.44-2.91). Neonatal outcomes, including umbilical artery pH less than 7.0, Apgar score of 3 or less at 5 minutes, and hypoxic ischemic encephalopathy, were more common for those with an attempted operative vaginal delivery. This was not significant when cases with a nonreassuring fetal heart rate tracing were removed. CONCLUSION: Cesarean delivery after an attempt at operative vaginal delivery was not associated with adverse neonatal outcomes in the absence of a nonreassuring fetal heart rate tracing.
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U2 - 10.1097/AOG.0b013e3181bbf3be
DO - 10.1097/AOG.0b013e3181bbf3be
M3 - Article
C2 - 20168101
AN - SCOPUS:73549106130
SN - 0029-7844
VL - 114
SP - 1017
EP - 1022
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 5
ER -