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[Instrumental extraction in 2002 in the "AURORE" hospital network: incidence and serious neonatal complications]
O Dupuis1, R Silveira, T Redarce
1Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon 04, France. olivier.dupuis@chu-lyon.fr
Objectives:
The purpose of this study was to evaluate the incidence of forceps and vacuum application and the incidence of its related neonatal complications. This study was performed in a network of 37 maternity hospitals.
Patients And Method:
A postal questionnaire was sent to 156 obstetricians between February and March 2003.
Results:
Response rate was 78%. In 2002 the operative vaginal delivery rate was 11.2% of all live births. Forceps are the primary instruments (6.3%) whereas vacuum delivery rate was 4.9%. One obstetrician never uses forceps while 38 (31%) never use vacuum. Only 29 (24%) report using both instruments frequently. During 2002 no neonatal death related to an operative vaginal delivery was reported while 145 neonatal complications were (3.2%). Major complications were one depressed skull fracture (1/4589) and 14 extensive caput succedaneum (14/4589). Minor complications were cutaneous lesions (124/4589) and facial palsy (6/4589). Vacuum delivery was associated with a significantly higher extensive caput succedaneum rate (P = 0.018) while the only depressed skull fracture observed was related to forceps use. Forceps delivery was associated with a significantly higher cutaneous lesions rate (P < 0.001).
Discussion And Conclusions:
This study showed that, in 2002, operative vaginal deliveries still represent a significant amount of vaginal deliveries, a majority of obstetricians do not use both instrument and neonatal associated complications are frequent (3.2%) but rarely severe. Therefore, we believe that every method that allows a safe teaching of operative delivery should be promoted.
