Early Maternal and Neonatal Morbidity afterSpontaneous and Assisted Vaginal Delivery

Overview

Objective:
To evaluate the differences in early maternal and neonatal morbidity after spontaneousdelivery, forceps delivery and vacuumextraction.Design: Retrospective clinical study.Setting: Department of Obstetrics and Gynecology, University Hospital, Palacký University,Olomouc.Methods: The database of 8196 deliveries at our department in the time period from January 1995till September 2000 revealed 183 of forceps deliveries and 217 of vacuumextractions. The controlgroup included 200 randomly selected parturients with spontaneous vaginal delivery. The earlymaternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd+ IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence ofepisiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatalmorbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia,duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age,birthweight and the presence of intracranial and retinal bleeding. The statistical significance of thedifferences in the frequency of the above parameters was evaluated.Results: Spontaneous deliveries were associated with lower maternal morbidity according to themost of studied parameteres. Vacuumextraction had a lower frequency of maternal postpartumcomplications compared to forceps deliveries. Statistically valid differences were however foundonly at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics.The use of vacuumextraction seems to be connected with a higher risk of cephalhematomas(p=0.0051) and longer duration of hospitalization.Conclusions: From the point of view of early maternal morbidity the assisted vaginal delivery byvacuumextraction gives better results than by forceps. However vacuumextraction increasis therisk of cephalhematomas at newborn.

Key words:
earlymaternal and neonatalmorbidity, spontaneous delivery, forceps, vacuumextraction