[Maternal morbidity after operative vaginal delivery]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Context:

• Operative vaginal delivery (OVD) is frequently employed but carries known risks.
• Understanding the specific maternal morbidities associated with OVD is crucial for informed clinical decision-making and patient counseling.

Purpose:

• To comprehensively review and synthesize the evidence on maternal outcomes following operative vaginal delivery compared to spontaneous vaginal delivery.
• To identify specific risks associated with different instrumental types and delivery conditions.

Summary:

• Operative vaginal delivery significantly increases the risk of anal sphincter injury and subsequent anal incontinence, particularly when forceps are used.
• Associated risks include perineal tears, postpartum hemorrhage, urinary retention, perineal pain, dyspareunia, and sexual disorders.
• No significant difference in maternal outcomes was found between different types of forceps or vacuum extractors, though OVD increases occult anal sphincter injury risk.

Impact:

• Findings highlight the increased maternal morbidity associated with OVD, emphasizing the need for careful patient selection and skilled operative technique.
• Informs guidelines and patient education regarding the risks and benefits of operative versus spontaneous vaginal delivery.
• Contributes to a better understanding of long-term consequences such as anal incontinence and sexual dysfunction post-OVD.