In contrast with the increasing rate of cesarean delivery, the rates
of operative vaginal deliveries (via either vacuum or forceps), have decreased significantly during the past 15 years (34).
Operative vaginal delivery in the second stage of labor by experienced and well trained physicians should be considered a safe, acceptable alternative to cesarean delivery.
CONCLUSION: Using 6 cm as the cut - off for active labor, allowing adequate time for the second stage of labor, and
encouraging operative vaginal delivery, when appropriate, may be important strategies to reduce the primary cesarean delivery rate.
Among women who reached the second stage of labor, 17.3 % underwent cesarean delivery for arrest of descent before 2 hours and only 1.1 % were given a trial
of operative vaginal delivery.
Homebirth increases the risk of perinatal death and brain damage even though the incidence of
operative vaginal delivery was 3 - 4 times higher in the hospital group.
Not surprisingly, the risk of
operative vaginal delivery and the risk of emergency cesarean section are much higher in the hospital.
Operative vaginal delivery: Medical student teaching module.
Training in, and ongoing maintenance of, practical skills related to
operative vaginal delivery should be encouraged.
In addition to greater expectant management of the second stage, two other practices could potentially reduce cesarean deliveries in the second stage: 1)
operative vaginal delivery and 2) manual rotation of the fetal occiput for malposition.
Yet, comparison of the outcomes of
operative vaginal deliveries and unplanned cesarean deliveries shows no difference in serious neonatal morbidity (eg, intracerebral hemorrhage or death).
Manual rotation of the fetal occiput in the setting of fetal malposition in the second stage of labor is a reasonable intervention to consider before moving to
operative vaginal delivery or cesarean delivery.
Operative vaginal delivery.
You may be asked to wait longer or hold back a bit if you have had a cesarean section or
an operative vaginal delivery (with forceps or vacuum extraction).
This dramatic increase was a result of several changes in the practice environment, including the introduction of electronic fetal monitoring and a decrease in
operative vaginal deliveries and attempts at vaginal breech deliveries (8 — 11).
Planned out - of - hospital birth also had a statistically significant association with higher rates for 5 - minute Apgar scores of less than 7, neonatal seizures, neonatal ventilator support, maternal blood transfusion, and unassisted vaginal delivery but with lower rates of both admission to neonatal intensive care units and obstetrical interventions, including induction and augmentation of labor,
operative vaginal delivery, cesarean delivery, and severe perineal lacerations.
«There have been no randomized trials of the total package of active management or of the use of strict diagnostic criteria alone, but trials of early amniotomy, early oxytocin, and these interventions combined do not suggest that these interventions are effective in reducing rates of cesarean sections or
operative vaginal deliveries.
Meta - analysis of the 10 randomized trials of a continuous companion throughout labor shows such support «is effective in reducing analgesia requirements, lowers the incidence of cesarean section and
operative vaginal delivery, and improves fetal outcome» (Thornton and Lilford 1994).
Only 1.1 % of these women were given a trial of
operative vaginal delivery.
The researchers assessed maternal complications according to the incidence of cesarean sections (CS),
operative vaginal deliveries (OVD), retained placentas or post-partum hemorrhages.
«We found that women with intrapartum fever had higher rates of
operative vaginal deliveries (34.3 % versus 19.6 %) and cesarean sections (20.7 % versus 8.7 %),» Dr. Hiersch says.