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Decision to delivery intervals for assisted vaginal vertex delivery
Y Okunwobi-Smith1, I Cooke, I Z MacKenzie
1Nuffield Department of Obstetrics and Gynaecology, University of Oxford, John Radcliffe Hospital, UK.
Summary
For operative vaginal delivery, forceps are faster than ventouse when fetal distress is present, with similar outcomes for mother and baby. Speed of delivery is crucial in fetal distress cases.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatal Outcomes
Background:
- Operative vaginal delivery is common for fetal distress or prolonged labor.
- The time from decision to delivery is a critical factor in maternal and neonatal outcomes.
- Understanding delivery intervals and instrument choice is vital for clinical practice.
Purpose of the Study:
- To analyze the decision-to-delivery interval in operative vaginal births.
- To compare this interval across different indications for operative vaginal delivery.
- To assess maternal and neonatal outcomes in relation to delivery speed and instrument used.
Main Methods:
- Prospective analysis of 225 women undergoing operative vaginal delivery.
- Singleton, cephalic presentation in the second stage of labor.
- Data collected on decision-to-delivery interval, indication, and maternal/neonatal outcomes.
Main Results:
- Mean decision-to-delivery interval was 34.4 minutes.
- Interval was significantly shorter for fetal distress (26.5 min) vs. other reasons (39.5 min).
- Forceps delivery was quicker than ventouse (23.3 min vs. 29.2 min) in fetal distress cases. Perineal repair needed more often after forceps (96%) than ventouse (87%).
Conclusions:
- Forceps offer a faster delivery than ventouse when speed is critical, particularly in fetal distress.
- Instrument choice does not compromise neonatal condition at delivery.
- Similar rates of perineal trauma observed between forceps and ventouse, irrespective of delivery interval.