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document
A randomised prospective study comparing the new vacuum extractor policy with forceps delivery . OBJECTIVE To compare assisted vaginal delivery by forceps with delivery by vacuum extractor , where a new vacuum extractor policy was employed which dictated the cup to be used in specific situations . DESIGN Multicentre randomised controlled trial . SETTING Four district general hospitals in the West Midlands . SUBJECTS Six hundred-seven women requiring assisted vaginal delivery , of whom 296 were allocated to vacuum extractor delivery and 311 to forceps . MAIN OUTCOME MEASURES Delivery success rate , maternal perineal and vaginal injuries , maternal anaesthetic requirements , neonatal scalp and facial injuries . RESULTS Of the vacuum extractor group , 85 % were delivered by the allocated instrument compared to 90 % in the forceps group ( odds ratio ( OR ) 0.64 ; 95 % confidence intervals ( CI ) 0.4-1.04 ) . However , more women in the vacuum extractor group were delivered vaginally ( 98 % ) than in the forceps group ( 96 % ) . There were significantly fewer women with anal sphincter damage or upper vaginal extensions in the vacuum extractor group ( 11 % vs 17 % , OR 0.6 ; 95 % CI , 0.38-0.97 ) . There were significantly fewer women in the vacuum extractor group requiring epidural or spinal anaesthetics ( 25.4 % vs 32.7 % , OR 0.69 ; 95 % CI 0.49-0.99 ) or general anaesthetics ( 1 % vs 4 % , OR 0.17 ; 95 % CI 0.04-0.76 ) . Although there were significantly more babies in the vacuum extractor group with cephalhaematomata ( 9 % vs 3 % , OR 3.3 ; 95 % CI 1.4-7.4 ) there were fewer babies in the vacuum extractor group with other facial injuries . There were three babies in the forceps group with unexplained neonatal convulsions . CONCLUSIONS Assisted vaginal delivery using the new vacuum extractor policy is associated with significantly less maternal trauma than with forceps . Further studies are required to assess neonatal morbidity adequately .
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Intervention_Surgical
allocated to vacuum extractor delivery and 311 to forceps .
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Outcome_Physical
Delivery success rate , maternal perineal and vaginal injuries , maternal anaesthetic requirements , neonatal scalp and facial injuries .
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Outcome_Physical
anal sphincter damage or upper vaginal extensions
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Outcome_Physical
epidural or spinal anaesthetics
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Outcome_Physical
general anaesthetics
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Outcome_Adverse-effects
cephalhaematomata
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Outcome_Physical
facial injuries
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Outcome_Adverse-effects
unexplained neonatal convulsions
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Outcome_Physical
.
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Outcome_Physical
maternal trauma
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Participant_Sample-size
Six hundred-seven
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Participant_Condition
assisted vaginal delivery
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Participant_Sample-size
296