Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.

OBJECTIVE To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries. DESIGN Population based study. SETTING US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file. PARTICIPANTS Singleton live births in the United States (n = 11 639 388) and New Jersey (n = 375 351). MAIN OUTCOME MEASURES Neonatal morbidity and mortality. RESULTS Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95% confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and need for assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; > or = 30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery. The sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears. CONCLUSION Although vacuum extraction does have risks, it remains a safe alternative to forceps delivery.