Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study

Murphy, Deirdre J.; Liebling, Rachel; Verity, Lisa; Swingler, Rebecca; Patel, Roshni

doi:10.1016/s0140-6736(01)06341-3

Cited by 329 publications

(207 citation statements)

References 16 publications

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“…Caesarean delivery has been shown to be protective against neonatal trauma in comparison with vaginal delivery when operative delivery is required in the second stage of labour 7 21. Our study demonstrated a striking reduction in risk of significant neonatal trauma with caesarean delivery compared with vaginal delivery, especially when type of labour was considered.…”

Section: Discussionmentioning

confidence: 52%

“…Risk factor analyses have suggested that caesarean delivery is an independent predictive factor for RDS (OR = 2.3 for caesarean delivery, especially for caesarean without labour (OR = 2.6) 15. Outcomes analyses (examining women with previous caesarean delivery) report increased risks of RDS13 17 and other measures of neonatal respiratory morbidity 7 12 13. Our study demonstrated very low rates (<1%) of significant neonatal respiratory complications such as RDS and aspiration pneumonitis following any method of delivery, which is consistent with most recent studies12 13 15 17 20 but lower than others,11 19 and may be explained by the large population-based cohort examined in our study.…”

Section: Discussionmentioning

confidence: 99%

“…These increasing rates have been explained in part by changing maternal characteristics4 and obstetric practice patterns,1 4 and by continued interest in “patient choice” caesarean delivery 5 6. Recent population-based determinations of outcomes by type of labour and by method of delivery have improved our understanding of the maternal risks with caesarean and operative vaginal delivery 7 – 10. Information on neonatal outcomes associated with method of delivery has focused on respiratory morbidity,11 – 17 and may have been influenced by gestational age at delivery,11 18 and the presence of maternal complications11 or previous obstetric interventions 12 13 19.…”

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confidence: 99%

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Neonatal outcomes with caesarean delivery at term

Liston

Allen

O’Connell

et al. 2008

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objective: To estimate the impact of caesarean delivery on the incidence of selected neonatal outcomes. Patients and methods: A 15-year, population-based, cohort study (1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) using the Nova Scotia Atlee Perinatal Database compared neonatal outcomes in term newborns born by spontaneous and assisted vaginal delivery, with newborns born by caesarean delivery, with and without labour, using multiple logistic regression. Results: From a total of 142 929 deliveries, there were 27 263 caesarean deliveries, 61% of which were performed in labour. Relative risks were adjusted for year of birth, maternal age, parity, smoking, maternal weight at delivery, hypertensive diseases, diabetes, previous caesarean delivery, use of regional anaesthesia, induction of labour, gestational age at delivery and large and small for gestational age, where significant. Caesarean delivery in labour, but not caesarean delivery without labour, had increased risks for depression at birth and neonatal respiratory conditions compared with spontaneous or assisted vaginal delivery. Compared with spontaneous vaginal delivery and assisted vaginal delivery, the risk of major neonatal birth trauma was decreased for infants after caesarean delivery with labour (odds ratio (OR) = 0.34, 95% CI 0.21 to 0.56 and OR = 0.07, 95% CI 0.04 to 0.11, respectively) and caesarean delivery without labour (OR = 0.20, 95% CI 0.08 to 0.52 and OR = 0.04, 95% CI 0.02 to 0

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Neonatal outcomes with caesarean delivery at term

Liston

Allen

O’Connell

et al. 2008

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…Evidence is also growing that maternal choice is being limited, with some North American maternity units declining access to vaginal birth after caesarean section 13. We have previously reported that 4% of women in a UK population needed a trial of instrumental delivery in theatre or a caesarean section at full dilatation, suggesting that difficult operative deliveries in the second stage of labour are at least as common as breech presentation at term 14. We found an excess of early maternal morbidity and admission to the neonatal intensive care unit after caesarean section and an excess of neonatal trauma after instrumental vaginal delivery.…”

Section: Introductionmentioning

confidence: 66%

Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study

Bahl

Strachan

Murphy

2004

BMJ

Self Cite

141

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Objective To evaluate the reproductive outcome and the mode of delivery in subsequent pregnancies after instrumental vaginal delivery in theatre or caesarean section at full dilatation. Design Prospective cohort study. Setting Two urban hospitals with a combined total of 10 000 deliveries a year. Participants A cohort of 393 women with term, singleton, cephalic pregnancies who needed operative delivery in theatre during the second stage of labour from February 1999 to February 2000. Postal questionnaires were received from 283 women (72%) at three years after the initial delivery. Main outcome measure Mode of delivery in the subsequent pregnancy. Results 140 women (49%) achieved a further pregnancy at three years. 91/283 (32%) women wished to avoid a further pregnancy. Women were more likely to aim for vaginal delivery (87% (47/54) v 33% (18/54); adjusted odds ratio 15.55 (95% confidence interval 5.25 to 46.04)) and more likely to have a vaginal delivery (78% (42/54) v 31% (17/54); 9.50 (3.48 to 25.97)) if they had had a previous instrumental vaginal delivery rather than a caesarean section. There was a high rate of vaginal delivery after caesarean section among women who attempted vaginal delivery 17/18 (94%). In both groups, fear of childbirth was a frequently reported reason for avoiding a further pregnancy (51% after instrumental vaginal delivery, 42% after caesarean section; 1.75 (0.58 to 5.25)). Conclusion Instrumental vaginal delivery offers advantages over caesarean section for future delivery outcomes. The psychological impact of operative delivery requires urgent attention.

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“…This morbidity is compounded by the difficulties encountered during delivery, and Towner et al (1999) reported that compared with vacuum extraction alone, caesarean delivery after a failed attempt at operative vaginal delivery was associated with significantly higher rates of subdural or cerebral hemorrhage, convulsions, and mechanical ventilation in the neonates. Furthermore, maternal morbidity with operative delivery in the second stage of labour is greater after caesarean section than after successful instrumentation, and is reduced if the delivery is conducted by a skilled obstetrician (Murphy et al 2001). Hence, the recommendations from the RCOG in the form of Green Top guidelines for operative vaginal delivery, which suggest that all operators should undergo training before progressing to unsupervised use of an instrument (Strachan and Murphy 2000), and this call for better training in the use of instruments used at the time of vaginal operative delivery has also been reiterated in the UK (Spencer et al 2006) and also raised in North America (ACOG 2000).…”

Section: Introductionmentioning

confidence: 99%

Changing trends in operative delivery performed at full dilatation over a 10-year period

Loudon¹,

Groom²,

Hinkson³

et al. 2010

Journal of Obstetrics and Gynaecology

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This study was a systematic anonymous audit of routinely collected data in a tertiary referral obstetric unit in London and included data from deliveries over a 10-year period (1992-2001). Data for all caesarean sections at full dilatation were collected, including maternal demographic information, the grade of operating clinician, and the place of delivery. Neonatal data collected included birth weight and umbilical arterial pH. No changes in the demographics of the population were observed. No increased rates of malposition were observed. Birth weight did not change. Increasing preference for the ventouse over forceps (ratio 0.2:1 to 1.9:1) over the decade (p = 0.002) was seen with an increased tendency to conduct the delivery in the operating theatre (p = 0.0025). Rate of caesarean section at full dilatation increased (2% by 2001). Increasing failures of operative vaginal delivery, especially using the ventouse (regression coefficient p = 0.025), and reduced attempts at instrumentation (regression coefficient p = 0.002) were seen.

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Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study

Cited by 329 publications

References 16 publications

Neonatal outcomes with caesarean delivery at term

Neonatal outcomes with caesarean delivery at term

Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study

Changing trends in operative delivery performed at full dilatation over a 10-year period

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