Trends in operative vaginal delivery rates and associated maternal complication rates in an inner-city hospital

Abstract

OBJECTIVE: The aims of this study were to determine trends in operative vaginal delivery rates in a large inner-city hospital and to assess associated risks. STUDY DESIGN: We performed a retrospective cohort study (1980-1996) of women with singleton term pregnancies who underwent operative vaginal delivery at Grady Memorial Hospital, Atlanta. Maternal complication rates were compared between forceps-assisted and vacuum-assisted methods. RESULTS: There was a decline in forceps-assisted deliveries during the 1960s and an increase during the 1990s. The vacuum-assisted delivery rate was exceedingly low during the 1980s and increased during the 1990s. Women who underwent forceps-assisted delivery were more likely to be <24 years old, to be nulliparous, and to have had regional anesthesia, midline episiotomies, and infant presentations other than occipitoanterior (P < .001). Women who underwent forceps-assisted deliveries had increased risks of postpartum infection, cervical laceration, prolonged hospital stay, perineal laceration, and postpartum complications. CONCLUSION: There were upward trends in the rates of operative vaginal delivery at this inner-city hospital. Women who underwent forceps-assisted delivery had greater rates of maternal complications than did those who underwent vacuum-assisted delivery.