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Operational Delivery with Vacuum Extraction Appears as Safe as Forceps Assisted Delivery

Vacuum extraction appears to be at least as safe as forceps delivery, according to the findings of a population based retrospective study conducted in the United States.

"Fatal complications and outcomes (neonatal death and intracranial haemorrhage) were similar between neonates and infants from two large birth cohorts in the United States after delivery by forceps or vacuum extraction," writes Kitaw Demissie, assistant professor, Division of Epidemiology, University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway, and colleagues.

They compared the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries in 11 639 388 singleton live births identified through the Centers for Disease Control and Prevention's natality and mortality birth cohort file between 1995 and 1998. The investigators also used data from 375 351 births identified through the linked natality, mortality, and hospital discharge summary birth cohort file for New Jersey from 1989 to 1993 to conduct additional assessments of neonatal morbidity.

Delivery assisted by vacuum or forceps showed similar risk of neonatal mortality, odds ratio (OR) 0.94, after adjusting for maternal age, race, parity, education, gestational age, birth weight, diabetes, pre-existing hypertension, pregnancy induced hypertension, premature rupture of membranes, induction of labour, foetal distress, placental abruption, and intrapartum bleeding in the national cohort.

In this group vacuum delivery was associated with a lower risk of birth injuries, OR 0.69; neonatal seizures, OR 0.78; and assisted ventilation at less than 30 minutes after birth, OR 0.94, as well as at 30 minutes or more after birth, OR 0.92, compared with forceps assisted delivery.

In the New Jersey cohort the incidence of cephalohaematoma was higher with vacuum delivery and the incidence of facial nerve injury was higher with forceps delivery. Adjusted analyses revealed that compared with forceps, vacuum assisted delivery had an OR of 2.00 for shoulder dystocia, 1.15 for feeding difficulty, 1.27 for mechanical ventilation, but 0.78 for retinal haemorrhage.

Analysis of maternal morbidity showed that third and fourth degree perineal tear was less likely with vacuum assisted delivery, ORs of 0.78 and 0.64, but postpartum haemorrhage was slightly more likely, OR of 1.22, compared with forceps assisted delivery.


"Although delivery by vacuum extraction does have risks, it remains a safe alternative to forceps delivery," the authors conclude, adding "Our results underscore the need for obstetric standards in performing instrumental deliveries."

BMJ 2004;329:24-29, doi:10.1136/bmj.329.7456.24

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