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Updated: Jun 16, 2026

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Failed operative vaginal delivery.

James M Alexander1, Kenneth J Leveno, John C Hauth

  • 1From the Departments of Obstetrics and Gynecology at the University of Texas Southwestern Medical Center, Dallas, Texas; the University of Alabama at Birmingham, Birmingham, Alabama; the Ohio State University, Columbus, Ohio; the University of Utah, Salt Lake City, Utah; the University of Pittsburgh, Pittsburgh, Pennsylvania; Wake Forest University Health Sciences, Winston-Salem, North Carolina; Thomas Jefferson University, Philadelphia, Pennsylvania; Wayne State University, Detroit, Michigan; the University of Cincinnati, Cincinnati, Ohio; the University of Miami, Miami, Florida; the University of Tennessee, Memphis, Tennessee; the University of Texas Health Science Center at San Antonio, San Antonio, Texas; Vanderbilt University, Nashville, Tennessee; the George Washington University Biostatistics Center, Washington, DC, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

Obstetrics and Gynecology
|February 20, 2010
PubMed
Summary

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This summary is machine-generated.

Cesarean delivery after attempting operative vaginal delivery did not increase adverse neonatal outcomes. This finding holds true when nonreassuring fetal heart rate tracings are excluded, suggesting safety in specific scenarios.

Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Neonatal Outcomes

Background:

  • Second-stage cesarean delivery is performed when vaginal birth is not progressing.
  • The decision to attempt operative vaginal delivery before cesarean delivery can impact maternal and neonatal outcomes.
  • Understanding these outcomes is crucial for clinical decision-making.

Purpose of the Study:

  • To compare maternal and neonatal outcomes between women undergoing second-stage cesarean delivery (CS) with and without a prior trial of operative vaginal delivery (OVD).
  • To identify specific risk factors and outcomes associated with attempting OVD before CS.

Main Methods:

  • Secondary analysis of women undergoing second-stage CS.
  • Maternal outcomes included: blood transfusion, endometritis, wound complications, anesthesia use, and maternal death.

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  • Neonatal outcomes included: low umbilical artery pH, low Apgar scores, seizures, hypoxic ischemic encephalopathy, stillbirth, skull fracture, and neonatal death.
  • Main Results:

    • Of 3,189 women, 640 had attempted OVD prior to CS.
    • Attempted OVD was associated with higher rates of wound complications and general anesthesia use.
    • Neonatal outcomes like low umbilical artery pH, low Apgar scores, and hypoxic ischemic encephalopathy were more frequent after attempted OVD, but not significant when nonreassuring fetal heart rate tracings were excluded.

    Conclusions:

    • Second-stage CS following an attempted OVD is not linked to adverse neonatal outcomes when nonreassuring fetal heart rate tracings are absent.
    • Clinical management should consider fetal heart rate status when evaluating risks associated with attempted OVD before CS.