TY  - BOOK
AU  - Grantz, Katherine L
AU  - Halscott, Torre L
AU  - Huang, Chun Chih
AU  - Iqbal, Sara N
AU  - Landy, Helain J
AU  - Ramsey, Patrick S
AU  - Reddy, Uma M
TI  - Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor
SN  - 0029-7844
PY  - 2015///
KW  - *Cesarean Section/ae [Adverse Effects]
KW  - *Extraction, Obstetrical/ae [Adverse Effects]
KW  - *Infant, Newborn, Diseases/et [Etiology]
KW  - *Labor Stage, Second
KW  - *Obstetric Labor Complications/et [Etiology]
KW  - Adult
KW  - Extraction, Obstetrical/mt [Methods]
KW  - Female
KW  - Humans
KW  - Infant, Newborn
KW  - Infant, Newborn, Diseases/ep [Epidemiology]
KW  - Logistic Models
KW  - Obstetric Labor Complications/ep [Epidemiology]
KW  - Odds Ratio
KW  - Pregnancy
KW  - Retrospective Studies
KW  - MedStar Health Research Institute
KW  - MedStar Washington Hospital Center
KW  - Obstetrics and Gynecology, Maternal-Fetal Medicine
KW  - Evaluation Studies
KW  - Journal Article
KW  - Research Support, N.I.H., Extramural
KW  - Research Support, N.I.H., Intramural
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
N2  - CONCLUSION: A trial of forceps delivery from a low station compared with cesarean delivery was associated with decreased neonatal morbidity among neonates born to nulliparous women; LEVEL OF EVIDENCE: II; METHODS: Retrospective study of 2,518 women carrying singleton fetuses at 37 weeks of gestation or greater who underwent attempted forceps-assisted delivery, attempted vacuum-assisted vaginal delivery, or cesarean delivery from a low station in the second stage of labor. Primary outcomes were stratified by parity and included a maternal adverse outcome composite (postpartum hemorrhage, transfusion, endometritis, peripartum hysterectomy, or intensive care unit admission) and a neonatal adverse outcome composite (5-minute Apgar score less than 4, respiratory morbidity, neonatal intensive care unit admission, shoulder dystocia, birth trauma, or sepsis); OBJECTIVE: To evaluate maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor; RESULTS: In nulliparous patients, the maternal adverse composite was not significantly different between women who underwent attempted forceps (12.1% compared with 10.8%, adjusted odds ratio [OR] 0.77, 95% confidence interval [CI] 0.40-1.34) or vacuum (8.3% compared with 10.8%, adjusted OR 0.68, 95% CI 0.40-1.16) delivery compared with cesarean delivery. Among parous women, the maternal adverse composite was not significantly different with attempted forceps (10.7% compared with 12.5%, adjusted OR 0.40, 95% CI 0.09-1.71) or vacuum (11.3% compared with 12.5%, adjusted OR 0.44, 95% CI 0.11-1.72) compared with cesarean delivery. Compared with neonates delivered by cesarean, the neonatal adverse composite was significantly lower among neonates born to nulliparous women who underwent attempted forceps (9.4% compared with 16.7%, adjusted OR 0.44, 95% CI 0.27-0.72) but not among those who underwent vacuum delivery (11.9% compared with 16.7%, adjusted OR 0.68, 95% CI 0.44-1.04). Among parous women, the neonatal adverse composite was not significantly different after attempted forceps (4.1% compared with 12.5%, adjusted OR 0.28, 95% CI 0.06-1.35) or vacuum (12.5% compared with 12.5%, adjusted OR 1.03, 95% CI 0.28-3.87) compared with cesarean delivery
ER  -