Maternal and neonatal trauma following operative vaginal delivery

Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variatio...

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Vydáno v:	Canadian Medical Association journal (CMAJ) Ročník 194; číslo 1; s. E1 - E12
Hlavní autoři:	Muraca, Giulia M., Boutin, Amélie, Razaz, Neda, Lisonkova, Sarka, Joseph, KS, John, Sid, Ting, Joseph Y., Scott, Heather, Kramer, Michael S.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Canada Elsevier Inc 10.01.2022 CMA Joule Inc CMA Impact, Inc
Témata:	Anal Canal - injuries Birth injuries Birth Injuries - epidemiology Birth Injuries - etiology Canada - epidemiology Cesarean section Childbirth Childbirth & labor Female Fractures Health aspects Hospitals Humans Iatrogenic diseases Incidence Injuries Internal Medicine Intracranial Hemorrhages - epidemiology Intracranial Hemorrhages - etiology Lacerations - epidemiology Lacerations - etiology Maternal & child health Neonatal Brachial Plexus Palsy - epidemiology Neonatal Brachial Plexus Palsy - etiology Nervous system Newborn babies Obstetric Labor Complications - epidemiology Obstetric Labor Complications - etiology Obstetrical Forceps - adverse effects Obstetrics Paralysis Pelvis - injuries Pregnancy Risk factors Skull Fractures - epidemiology Skull Fractures - etiology Statistics Surgery Trauma Trauma, Nervous System - epidemiology Trauma, Nervous System - etiology Urethra - injuries Urinary Bladder - injuries Vacuum Extraction, Obstetrical - adverse effects Vagina Vagina - injuries Wounds and injuries Canada Quebec Canada
ISSN:	0820-3946, 1488-2329, 1488-2329
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Abstract	Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%–25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6–10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%–13.4%) and 9.6 (95% CI 9.0–10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65–1.75) and varied by region, but not by level of obstetric care. In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
AbstractList	Background: Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. Methods: We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Results: Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care. Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada. Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada. Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.BACKGROUNDOperative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.METHODSWe conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.RESULTSOf 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.INTERPRETATIONIn Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada. Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%–25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6–10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%–13.4%) and 9.6 (95% CI 9.0–10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65–1.75) and varied by region, but not by level of obstetric care. In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada. ABSTRACTBackgroundOperative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. MethodsWe conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. ResultsOf 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%–25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6–10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%–13.4%) and 9.6 (95% CI 9.0–10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65–1.75) and varied by region, but not by level of obstetric care. InterpretationIn Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
Audience	Professional
Author	Muraca, Giulia M. Ting, Joseph Y. Scott, Heather Razaz, Neda Boutin, Amélie Lisonkova, Sarka Joseph, KS John, Sid Kramer, Michael S.
Author_xml	– sequence: 1 givenname: Giulia M. surname: Muraca fullname: Muraca, Giulia M. email: giulia.muraca@ki.se organization: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC – sequence: 2 givenname: Amélie surname: Boutin fullname: Boutin, Amélie organization: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC – sequence: 3 givenname: Neda surname: Razaz fullname: Razaz, Neda organization: Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden – sequence: 4 givenname: Sarka surname: Lisonkova fullname: Lisonkova, Sarka – sequence: 5 givenname: KS surname: Joseph fullname: Joseph, KS – sequence: 6 givenname: Sid surname: John fullname: John, Sid organization: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC – sequence: 7 givenname: Joseph Y. surname: Ting fullname: Ting, Joseph Y. organization: Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC – sequence: 8 givenname: Heather surname: Scott fullname: Scott, Heather organization: Department of Obstetrics and Gynaecology, Dalhousie University and the IWK Health Centre, Halifax, NS – sequence: 9 givenname: Michael S. surname: Kramer fullname: Kramer, Michael S. organization: Departments of Epidemiology and Occupation Health and of Pediatrics, McGill University, Montréal, Que
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/35012946$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:148532935$$DView record from Swedish Publication Index (Karolinska Institutet)
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Snippet	Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given... ABSTRACTBackgroundOperative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have... Background: Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined... Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD...
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SubjectTerms	Anal Canal - injuries Birth injuries Birth Injuries - epidemiology Birth Injuries - etiology Canada - epidemiology Cesarean section Childbirth Childbirth & labor Female Fractures Health aspects Hospitals Humans Iatrogenic diseases Incidence Injuries Internal Medicine Intracranial Hemorrhages - epidemiology Intracranial Hemorrhages - etiology Lacerations - epidemiology Lacerations - etiology Maternal & child health Neonatal Brachial Plexus Palsy - epidemiology Neonatal Brachial Plexus Palsy - etiology Nervous system Newborn babies Obstetric Labor Complications - epidemiology Obstetric Labor Complications - etiology Obstetrical Forceps - adverse effects Obstetrics Paralysis Pelvis - injuries Pregnancy Risk factors Skull Fractures - epidemiology Skull Fractures - etiology Statistics Surgery Trauma Trauma, Nervous System - epidemiology Trauma, Nervous System - etiology Urethra - injuries Urinary Bladder - injuries Vacuum Extraction, Obstetrical - adverse effects Vagina Vagina - injuries Wounds and injuries
Title	Maternal and neonatal trauma following operative vaginal delivery
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