Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Epidemiology

Background:

• Global operative vaginal delivery rates are declining, with a trend towards vacuum extraction.
• Trends in operative vaginal delivery in Singapore remain largely uncharacterized.
• Understanding these trends is crucial for maintaining obstetric skills and managing delivery outcomes.

Purpose of the Study:

• To analyze trends in operative vaginal delivery at Singapore General Hospital (SGH) from 2012 to 2017.
• To compare maternal and neonatal outcomes between forceps- and vacuum-assisted deliveries.
• To investigate obstetricians' instrument preferences.

Main Methods:

• Retrospective study of 906 operative vaginal deliveries (2012-2017) at SGH.
• Comparison of maternal outcomes (postpartum hemorrhage, OASI) and neonatal outcomes (NICU admission, significant events) between forceps and vacuum groups.
• Analysis of obstetrician instrument preference based on year of graduation.

Main Results:

• Operative vaginal delivery rate was stable at approximately 10% throughout the study period.
• Neonatal cephalohematomas were more frequent with vacuum-assisted deliveries.
• No significant differences in other maternal or neonatal outcomes were observed; NICU admissions were unrelated to delivery mode.

Conclusions:

• Maternal and neonatal morbidity rates were low at SGH.
• Balanced use of forceps and vacuum indicates operator proficiency.
• Operative vaginal delivery is essential for safe delivery and managing Cesarean section rates.