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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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) Vol. 194; no. 1; pp. E1 - E12
Main Authors: Muraca, Giulia M., Boutin, Amélie, Razaz, Neda, Lisonkova, Sarka, Joseph, KS, John, Sid, Ting, Joseph Y., Scott, Heather, Kramer, Michael S.
Format: Journal Article
Language:English
Published: Canada Elsevier Inc 10.01.2022
CMA Joule Inc
CMA Impact, Inc
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.210841