This cohort study assesses whether implementation of a validated calculator for likelihood of cesarean delivery at the time of labor induction is associated with maternal morbidity and birth satisfaction.

No abstract

A retrospective cohort study of women with a retained placenta after vaginal birth who underwent placental removal either manually or with the Bierer forceps from 2013-2019 at two hospitals. Those whose placentas were unable to be removed by initial modality were then attempted with the other modality. We compared likelihood of successful removal and need for a second removal modality as well as complications associated with each technique using univariate analysis. RESULTS: 156 patients were included for analysis. 25 patients (16.1%) had initial attempt with Bierer forceps, and 131 (84.0%) had initial attempt with manual removal. 4 (16.0%) of patients initially treated with instrumental removal and 19 (14.5%) patients initially treated with manual removal required the second maneuver to successfully remove the placenta. Table 1 shows reasons why the initial maneuver was unsuccessful. Estimated blood loss was similar between the two groups (716.0 ml for manual removal vs 555.8ml for instrumental removal, p¼0.9). The mean entire length of the third stage was 59 min (IQR 45-67) in those with initial instrumental removal and 49 min (IQR 15-45.5) in those with initial manual removal. There were no differences in complication rates between the two groups (Figure 1). CONCLUSION: The use of Bierer forceps is a safe, well tolerated, and effective option for removal of retained placenta at the time of vaginal delivery.