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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Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0820-3946 1488-2329 1488-2329
DOI:	10.1503/cmaj.210841