Operative vaginal delivery (VD) remains an essential component of labor management, accounting for 3% to 6% of all deliveries, and includes forceps and vacuum-assisted births. Operative VD is used to expedite safe VD for maternal and/or fetal indications.1,2
Operative VD can cause significant maternal and fetal morbidities.3-5 These should be compared to cesarean delivery (CD) outcomes, and maternal and fetal complications should be considered for both prior to operative VD.
Maternal complications from operative VD include increased rates of the following:
Newborn complications from operative VD vary somewhat based on the device used. They include increased rates of the following:
Brachial plexus injury
Facial nerve palsy
External ocular injury
Specific criteria must be met prior to operative VD. This includes fetal vertex presentation, fully dilated cervix, known fetal head position, obstetrician’s familiarity and experience with an instrument, and ability to perform an emergency CD if needed, to name a few.
Operative VD is contraindicated in the following instances:
Fetal head is not engaged.
The position of the head is not known.
Fetus has a known or suspected bone demineralization condition.
Fetus has a known or suspected bleeding disorder.
In order to perform an operative VD, a parturient has to have adequate anesthesia. The anesthesiologist should be alerted and present, and should assess the epidural level and functional status prior to obstetricians initiating operative VD. We recommend a 5- to 10-mL bolus of 3% bicarbonated chloroprocaine epidurally to aid maternal comfort for operative VD without hampering maternal pushing effort. An anesthesia provider should stay with the patient to ensure adequate anesthesia and be ready for an emergent CD, anticipating and managing any subsequent postpartum hemorrhage.
ACOG practice bulletin. Operative vaginal delivery. Obstet Gynecol.
ER. Vacuum assisted vaginal delivery. Rev Obstet Gynecol.
R. Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter? Arch Gynecol Obstet.
D. Immediate maternal ...