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Low volume forceps practice and anal sphincter injury rate

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

While the increased rates of high degree perineal tears were previously associated with the use of forceps, in the current era of low volume of forceps practice, factors associated with the occurrence of this potential complication remain understudied. We aim to evaluate factors associated with obstetric anal sphincter injury (OASIS) in obstetric units with a low volume forceps practice.

Methods

A retrospective cohort study was conducted at two tertiary medical centers. All singleton pregnancies delivered by forceps extraction between 2011 and 2019 were analyzed. Women who experienced anal sphincter injury were compared to those who did not.

Results

The study cohort included 764 forceps deliveries. There were 19 (2.5%) cases of OASIS. Women with anal sphincter injury had higher rates of gestational diabetes mellitus (21% vs. 5.6%, OR [95% CI] 4.46 (1.41–14.04), p = 0.02). Birth weights and the rate of macrosomia did not differ between groups. Induction of labor was more common among the OASIS group (68% vs. 41.7%, OR [95% CI] 3.0 (1.1–8.0), p = 0.02). Sequential use of forceps (after failed vacuum attempt) was associated with OASIS (8 (42%) vs. 76 (10.2%), OR [95% CI] 6.4 (2.5–16.4), p < 0.001). In a multivariate logistic regression, sequential forceps was the only factor independently associated with OASIS (OR [95% CI] 4.7 (1.3–18.2), p = 0.02).

Conclusions

Rate of OASIS was relatively low in the current cohort. Sequential use of forceps was found to be the most important determinant in OASIS occurrence.

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Abbreviations

FE:

Forceps extraction

OASIS:

Obstetric anal sphincter injury

References

  1. Bulletins—obstetrics cop (2015) ACOG practice bulletin no. 154: Operative vaginal delivery. Obstet Gynecol 126: e56–65.

  2. Patel RR, Murphy DJ (2004) Forceps delivery in modern obstetric practice. BMJ 328:1302–1305

    Article  Google Scholar 

  3. Jeon J, Na S (2017) Vacuum extraction vaginal delivery: current trend and safety. Obstet Gynecol Sci 60:499–505

    Article  Google Scholar 

  4. Caughey AB, Sandberg PL, Zlatnik MG, Thiet MP, Parer JT, Laros RK (2005) Forceps compared with vacuum: rates of neonatal and maternal morbidity. Obstet Gynecol 106:908–912

    Article  Google Scholar 

  5. Burke N, Field K, Mujahid F, Morrison JJ (2012) Use and safety of Kielland’s forceps in current obstetric practice. Obstet Gynecol 120:766–770

    Article  Google Scholar 

  6. Pierre F, Jousse M (2008) Medico-legal incidence of instrumental delivery. J Gynecol Obstet Biol Reprod (Paris) 37(8):S276–S287

    Article  Google Scholar 

  7. Kyser KL, Lu X, Santillan D et al (2014) Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence? Acad Med 89:71–76

    Article  Google Scholar 

  8. Chiswick ML, James DK (1979) Kielland’s forceps: association with neonatal morbidity and mortality. Br Med J 1:7–9

    Article  CAS  Google Scholar 

  9. Gachon B, Fradet Menard C, Pierre F, Fritel X (2019) Does the implementation of a restrictive episiotomy policy for operative deliveries increase the risk of obstetric anal sphincter injury? Arch Gynecol Obstet 300:87–94

    Article  Google Scholar 

  10. Diko S, Guiahi M, Nacht A et al (2019) Prevention and management of severe obstetric anal sphincter injuries (OASIs): a national survey of nurse- midwives. Int Urogynecol J 15:1–4

    Google Scholar 

  11. Deane RP (2019) Operative vaginal delivery and pelvic floor complications. Best Pract Res Clin Obstet Gynaecol 56:81–92

    Article  Google Scholar 

  12. Bulletins—obstetrics ACOOAGCOP (2016) Practice bulletin no. 165: Prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 128: e1–e15.

  13. Bulletins—obstetrics COP (2017) Practice bulletin no. 183: Postpartum hemorrhage. Obstet Gynecol 130: e168–e86.

  14. Gynecologists ACOOA, Pregnancy TFOHI (2013) Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 122: 1122–31.

  15. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773

    Article  CAS  Google Scholar 

  16. Bulletins—obstetrics ACOOAGCOP (2003) ACOG practice bulletin number 49, December 2003: Dystocia and augmentation of labor. Obstet Gynecol 102: 1445-54

  17. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ (2015) Births: final data for 2013. Natl Vital Stat Rep 64:1–65

    PubMed  Google Scholar 

  18. Hehir MP, O’Connor HD, Kent EM et al (2012) Changes in vaginal breech delivery rates in a single large metropolitan area. Am J Obstet Gynecol 206(498):e1–4

    Google Scholar 

  19. Muraca GM, Skoll A, Lisonkova S et al (2018) Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery. BJOG 125:693–702

    Article  CAS  Google Scholar 

  20. Walsh CA, Robson M, McAuliffe FM (2013) Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol 121:122–128

    Article  Google Scholar 

  21. Levin G, Elchalal U, Yagel S et al (2019) Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 98:1464

    Article  CAS  Google Scholar 

  22. Murphy DJ, Macleod M, Bahl R, Strachan B (2011) A cohort study of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol 156:41–45

    Article  Google Scholar 

  23. Halscott TL, Reddy UM, Landy HJ et al (2015) Maternal and neonatal outcomes by attempted mode of operative delivery from a low station in the second stage of labor. Obstet Gynecol 126:1265–1272

    Article  Google Scholar 

  24. Alexander JM, Leveno KJ, Rouse DJ et al (2007) Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol 109:917–921

    Article  Google Scholar 

  25. Obstetricians-gynecologists ACO (2006) ACOG practice bulletin. episiotomy. Clinical management guidelines for obstetrician-gynecologists. number 71, April 2006. Obstet Gynecol 107: 957–62.

  26. Tähtinen RM, Cartwright R, Vernooij RWM et al (2019) Long-term risks of stress and urgency urinary incontinence after different vaginal delivery modes. Am J Obstet Gynecol 220:181.e1–81.e8

    Article  Google Scholar 

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Funding

No external funding was used in this conduct of this study.

Author information

Author notes

  1. Raanan Meyer and Amihai Rottenstreich contributed equally to this work.

Authors and Affiliations

  1. The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel

    Raanan Meyer & Salem Kees

  2. The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel

    Amihai Rottenstreich, Simcha Yagel & Gabriel Levin

  3. The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Michal Zamir

Authors
  1. Raanan Meyer
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  2. Amihai Rottenstreich
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  3. Salem Kees
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  4. Michal Zamir
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  5. Simcha Yagel
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  6. Gabriel Levin
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Contributions

All authors contributed to the manuscript. GL, RM, and AR reviewed the literature and wrote the paper. SK, SY, and MZ performed the procedures and collected the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gabriel Levin.

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Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required and was waived by the institutional review board approval. All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Meyer, R., Rottenstreich, A., Kees, S. et al. Low volume forceps practice and anal sphincter injury rate. Arch Gynecol Obstet 301, 1133–1138 (2020). https://doi.org/10.1007/s00404-020-05519-0

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  • DOI: https://doi.org/10.1007/s00404-020-05519-0

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