Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births

  • Review
  • Intervention

Authors


Abstract

Background

The majority of women have spontaneous vaginal births, but some women need assistance in the second stage with delivery of the baby, using either the obstetric forceps or vacuum extraction. Rates of instrumental vaginal delivery range from 5% to 20% of all births in industrialised countries. The majority of instrumental vaginal deliveries are conducted in the delivery room, but in a small proportion (2% to 5%), a trial of instrumental vaginal delivery is conducted in theatre with preparations made for proceeding to caesarean section.

Objectives

To determine differences in maternal and neonatal morbidity between women who, due to anticipated difficulty, have trial of instrumental vaginal delivery in theatre and those who have immediate caesarean section for failure to progress in the second stage.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2008).

Selection criteria

Randomised controlled trials comparing trial of instrumental vaginal delivery (vacuum extraction or forceps) in operating theatre to immediate caesarean section for women with failure to progress in the second stage (active second stage more than 60 minutes in primigravidae).

Data collection and analysis

We identified no studies meeting our inclusion criteria.

Main results

No studies were included.

Authors' conclusions

There is no current evidence from randomised trials to influence practice.

Plain language summary

Trial of instrumental birth in theatre versus immediate caesarean section for anticipated difficult assisted births

Most women give birth spontaneously, but some need assistance during the second stage of labour with obstetric forceps or the vacuum. The rates of instrumental vaginal births range from 5% to 20% of all births in high-income countries, with little information about the incidence in low-income countries. Indications for instrumental vaginal births are generally fetal heart rate abnormalities, poor position of the baby, maternal exhaustion and some maternal medical conditions such as heart disease. The majority of instrumental vaginal births are conducted in the delivery room, but in a small proportion of anticipated difficult births (2% to 5%), a trial of instrumental vaginal birth is conducted in theatre with preparations made for proceeding to caesarean section. It has been suggested that for these anticipated difficult assisted vaginal births, it may be preferable to go straight to caesarean section. The advantage of doing an immediate caesarean section would be a reduced risk of morbidity for both mother and baby from a failed attempted instrumental birth. However, the disadvantages of routinely doing a caesarean section in these circumstances are an increased risk of morbidity from caesarean section which often manifests itself at a subsequent birth. The review of trials looking at attempted instrumental delivery in theatre versus immediate caesarean section for anticipated difficult births identified no trials to help with making this decision. Further research is clearly needed.