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Labour and Delivery Posters
Maternal and neonatal morbidity in relation to the instrument used to assist in mid-cavity rotational operative vaginal delivery: a prospective cohort study
  1. MV Venne2,
  2. R Bahl1,
  3. M MacLeod3,
  4. BK Strachan1,
  5. DJ Murphy4
  1. 1St. Michael's Hospital, University hospitals Bristol, Bristol, United Kingdom
  2. 2Royal United Hospital, Bath, United Kingdom
  3. 3Ninewells Hospital and Medical School, Dundee, United Kingdom
  4. 4Trinity College Dublin & Coombe Women & Infants University Hospital, Dublin, Ireland


Introduction Various instruments are available to assist a mid-cavity delivery requiring rotation of the fetal head. There is a lack of robust evidence comparing maternal and neonatal morbidity associated with the use of these instruments.

Objective To compare the maternal and neonatal morbidity associated with instrument use to assist a mid-cavity rotational delivery.

Study design A prospective cohort study of 1360 nulliparous women had operative vaginal births in two university teaching hospitals in Scotland and England.

Results In this cohort, 381 women underwent a mid-cavity rotational delivery. One hundred and sixty three women underwent manual rotation followed by non-rotational forceps delivery,, 73 with the assistance of rotational vacuum and 145 with the assistance of rotational forceps. Women who underwent manual rotation and non-rotational forceps delivery were less likely to need moderate or strong analgesia compared to those delivered using rotational forceps (OR 0.56; 95% CI 0.28 - 0.98) but had a greater analgesia use than women delivered using rotational vacuum (OR 2.38; CI 1.23 - 4.59). Pelvic floor and neonatal morbidity was comparable with either instrument. Compared to manual rotational and non-rotational forceps use, sequential use of instruments was more likely with rotational vacuum use (OR 0.01; 95% CI 0.01- 0.09) and rotational forceps use (OR 0.07; 95% CI 0.01 - 0.63).

Conclusions Mid-cavity instrumental birth has good outcomes overall and the morbidity with Kiellands forceps is comparable to vacuum and manual rotation. Forceps deliveries have a greater analgesia usage whereas vacuum deliveries result in more sequential use of instruments.

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