Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births

Abstract

Background: The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section. Objectives: To determine differences in maternal and neonatal morbidity between women who, due to anticipated difficulty, have trial of instrumental vaginal delivery in theatre and those who have immediate caesarean section for failure to progress in the second stage. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2008). Selection criteria: Randomised controlled trials comparing trial of instrumental vaginal delivery (vacuum extraction or forceps) in operating theatre to immediate caesarean section for women with failure to progress in the second stage (active second stage more than 60 minutes in primigravidae). Data collection and analysis: We identified no studies meeting our inclusion criteria. Main results: No studies were included. Authors' conclusions: There is no current evidence from randomised trials to influence practice. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.