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Published on: June 6, 2020
Clinical and Physician Factors Associated With Failed Operative Vaginal Delivery
Danielle M Panelli1, Stephanie A Leonard, Noor Joudi
1Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, the Department of Obstetrics and Gynecology, Sutter Medical Center, Sacramento, and the California Maternal Quality Care Collaborative, Palo Alto, California.
Physician experience is linked to successful operative vaginal delivery, especially with forceps. More attempts by doctors correlate with fewer failures in operative vaginal births for nulliparous, term, singleton, vertex (NTSV) deliveries.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Outcomes Research
Background:
- Operative vaginal delivery is a key intervention for nulliparous, term, singleton, vertex (NTSV) births.
- Understanding factors influencing operative vaginal delivery success is crucial for optimizing obstetric care.
- Cesarean birth following failed operative vaginal delivery represents a significant clinical challenge.
Purpose of the Study:
- To identify clinical and physician-specific factors associated with failed operative vaginal delivery in NTSV births.
- To quantify the impact of physician experience on operative vaginal delivery outcomes.
- To inform strategies for improving operative vaginal delivery success rates.
Main Methods:
- Retrospective cohort study of NTSV live births with attempted operative vaginal delivery (2016-2020) in California.
- Primary outcome: cesarean birth after failed operative vaginal delivery, analyzed by device (vacuum/forceps).
- Multivariable mixed-effects Poisson regression models assessed risk ratios for clinical and physician exposures.
Main Results:
- 3.8% of 47,973 operative vaginal delivery attempts failed; forceps had higher failure rates than vacuum.
- Failed deliveries associated with older maternal age, higher BMI, obstructed labor, and higher birth weight.
- Increased physician experience correlated with lower failure rates, particularly for forceps (aRR 0.76).
Conclusions:
- Clinical factors like maternal BMI and fetal weight significantly impact operative vaginal delivery success.
- Physician experience is a critical factor in operative vaginal delivery outcomes, with notable benefits for forceps use.
- Findings support enhanced training and skill maintenance programs for operative vaginal delivery.
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