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Contemporary Trends in Operative Vaginal Delivery and Obstetric Anal Sphincter Injuries from 2016-2023.

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Operative vaginal delivery (OVD) rates, particularly forceps-assisted vaginal delivery (FAVD), have declined nationally. Despite this, obstetric anal sphincter injuries (OASIS) increased among FAVD cases, highlighting a critical need for improved training and safety protocols.

Keywords:
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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Maternal-Fetal Medicine

Background:

  • Operative vaginal delivery (OVD) rates, especially forceps-assisted vaginal delivery (FAVD), have declined significantly.
  • This decline is associated with concerns about skill retention and potential increases in obstetric anal sphincter injuries (OASIS).

Purpose of the Study:

  • To analyze national trends in OVD and associated OASIS rates between 2016 and 2023.
  • To identify risk factors for OASIS in operative vaginal deliveries.

Main Methods:

  • Cross-sectional study utilizing National Vital Statistics System birth certificate data (2016-2023).
  • Inclusion criteria: liveborn deliveries, 34-42 weeks gestation, maternal age 16-50.
  • Exclusion criteria: multifetal gestations, fetal anomalies, non-vertex presentations.
  • Joinpoint regression for trend analysis; multivariable logistic regression for risk factor assessment.

Main Results:

  • OVD composite rates decreased from 4.6% to 4.1% (AAPC -1.6%).
  • FAVD rates declined from 0.8% to 0.6% (AAPC -3.1%), while vacuum-assisted vaginal delivery (VAVD) rates decreased from 3.8% to 3.4% (AAPC -1.4%).
  • OASIS rates remained stable overall but significantly increased among FAVD cases (9.3% to 14.0%, AAPC 4.8%).
  • FAVD (aOR 9.50) and VAVD (aOR 3.90) were associated with higher OASIS likelihood compared to spontaneous vaginal birth.

Conclusions:

  • National OVD rates are declining, with a pronounced decrease in FAVD.
  • There is a concerning increase in OASIS rates specifically within FAVD.
  • Further research is needed on targeted interventions to improve FAVD proficiency and safety.