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Vacuum extraction versus forceps for assisted vaginal delivery.

R B Johanson¹, B K Menon

¹Academic Department of Obstetrics and Gynaecology, North Staffordshire Hospital NHS Trust, Maternity Hospital, Newcastle Road, Stoke-on-Trent, Staffordshire, UK, ST4 6QG. rbj@kogs.demon.co.uk

The Cochrane Database of Systematic Reviews

|May 5, 2000

Summary

Vacuum extraction for assisted vaginal delivery reduces maternal injury compared to forceps. However, it increases neonatal cephalhaematomas and retinal hemorrhages, though serious injury is rare with both methods.

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Area of Science:

Obstetrics and Gynecology
Perinatal Medicine
Surgical Interventions

Background:

Vacuum extraction is advocated for assisted vaginal delivery due to perceived lower maternal injury rates.
Debate exists regarding the optimal instrument for assisted vaginal delivery.

Purpose of the Study:

To compare vacuum extraction versus forceps for assisted vaginal delivery.
To assess effects on delivery success and maternal/neonatal outcomes.

Main Methods:

Systematic review of controlled trials from the Cochrane Pregnancy and Childbirth Group trials register (searched February 1999).
Inclusion of acceptably controlled comparisons of vacuum extraction and forceps delivery.
Independent quality assessment and data extraction by two reviewers.

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Main Results:

Ten trials of reasonable quality were included.
Vacuum extraction significantly reduced maternal trauma (OR 0.41) and need for anesthesia compared to forceps.
Vacuum extraction had higher success rates (OR 1.69) and fewer cesarean sections.
Increased neonatal cephalhaematomas and retinal hemorrhages were observed with vacuum extraction.
Serious neonatal injury was infrequent with both instruments.

Conclusions:

Vacuum extraction appears to lower maternal morbidity during assisted delivery compared to forceps.
The lower rates of cephalhaematoma and retinal haemorrhages with forceps may be a compensatory advantage.