Neonatal acidosis and method of delivery

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Surgical Outcomes

Background:

• Forceps-assisted delivery is a common obstetric procedure.
• Understanding the safety and efficacy of different forceps applications is crucial for clinical decision-making.
• Comparing forceps outcomes with spontaneous and cesarean deliveries provides essential comparative data.

Purpose of the Study:

• To compare neonatal and maternal outcomes of indicated low forceps, indicated midforceps, elective low forceps, spontaneous vaginal delivery, and cesarean delivery.
• To evaluate the incidence of fetal acidosis, Apgar scores, fetal trauma, and neurologic deficits across delivery methods.
• To assess maternal complications such as hematocrit changes and vaginal lacerations.

Main Methods:

• Retrospective comparison of 704 women undergoing forceps delivery (elective, indicated low, indicated midforceps) with 303 spontaneous and 111 cesarean deliveries.
• Analysis of fetal acidosis (pH < 7.20), one- and five-minute Apgar scores (<7), fetal trauma, and neurologic deficits.
• Assessment of maternal hematocrit levels and vaginal lacerations.

Main Results:

• No significant differences in fetal acidosis, Apgar scores, trauma, or neurologic deficits between indicated low/midforceps and cesarean sections for fetal distress or arrest of descent.
• Elective low forceps outcomes were comparable to spontaneous vaginal delivery regarding acidosis and Apgar scores.
• Midforceps deliveries were associated with significantly higher rates of maternal hematocrit changes and vaginal lacerations compared to low forceps.

Conclusions:

• Indicated low and selected midforceps operations demonstrate acceptable neonatal safety profiles when compared to cesarean sections.
• Elective low forceps deliveries are as safe as spontaneous vaginal deliveries for neonates.
• Maternal risks, specifically hematologic changes and lacerations, are higher with midforceps compared to low forceps, warranting careful selection.