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Choice of instruments for assisted vaginal delivery
Fidelma O'Mahony1, G Justus Hofmeyr, Vijay Menon
1Academic Unit of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Newcastle Road, Stoke-on-Trent, UK, ST4 6QG.
The Cochrane Database of Systematic Reviews
|November 12, 2010
Summary
Forceps and ventouse (vacuum extraction) are common assisted vaginal birth instruments. Forceps are more effective but increase maternal trauma risk, while ventouse devices pose risks to the baby.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Surgical Instruments in Obstetrics
Background:
- Instrumental or assisted vaginal birth is frequently employed to expedite delivery for maternal or fetal benefit.
- Complications for both mother and baby can arise from assisted vaginal birth.
- Instrument selection depends on clinical factors, operator preference, and instrument availability.
Purpose of the Study:
- To compare the effectiveness of different instruments used in assisted vaginal birth.
- To evaluate the rates of successful vaginal delivery and significant maternal and neonatal morbidity associated with various instruments.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted.
- The Cochrane Pregnancy and Childbirth Group's Trials Register was searched up to May 2010.
- Data on trial quality and outcomes were independently extracted and verified by two reviewers.
Main Results:
- Forceps had a lower failure rate for vaginal birth compared to ventouse but were associated with more maternal trauma, including severe perineal tears and incontinence.
- Facial injury was more common with forceps, while ventouse use, particularly metal cups, increased the risk of neonatal scalp injury and cephalhaematoma.
- Overall, forceps and metal cup ventouse devices were most effective for achieving vaginal birth, but with distinct maternal and neonatal risks.
Conclusions:
- Both forceps and ventouse devices have established roles in clinical practice.
- Operator training is crucial regardless of the instrument chosen.
- The choice of instrument should balance the risks of failed delivery against maternal and neonatal trauma, considering the hierarchy from forceps to metal cup to hand-held to soft cup vacuum extraction.
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