Perinatal and maternal outcomes by attempted midpelvic operative vaginal and cesarean deliveries with dystocia and prolonged second stage of labour (n = 17 484)*†
| Outcome | No. (%) of cesarean deliveries n = 9300 | Attempted midpelvic forceps delivery n = 4741 | Attempted midpelvic vacuum delivery n = 2780 | Attempted midpelvic sequential operative vaginal delivery n = 663 | |||
|---|---|---|---|---|---|---|---|
| No. (%) | AOR (95% CI) | No. (%) | AOR (95% CI) | No. (%) | AOR (95% CI) | ||
| Severe perinatal morbidity/mortality | 61 (0.7) | 52 (1.1) | 1.81 (1.24 to 2.64) | 32 (1.2) | 1.81 (1.17 to 2.80) | 13 (2.0) | 3.19 (1.73 to 5.88) |
| Stillbirth | 0 (0.0) | 0 (0.0) | – | < 5 (< 0.2) | – | 0 (0.0) | – |
| Neonatal death | 0 (0.0) | < 5 (< 0.1) | – | < 5 (< 0.2) | – | 0 (0.0) | – |
| Neonatal convulsion | 16 (0.2) | 8 (0.2) | 0.98 (0.42 to 2.29)††† | 6 (0.2) | 1.26 (0.49 to 3.21)††† | < 5 (< 0.8) | 1.76 (0.40 to 7.65)††† |
| Assisted ventilation (endotracheal) | 35 (0.4) | 10 (0.2) | 0.55 (0.27 to 1.13) | 9 (0.3) | 0.80 (0.38 to 1.67) | < 5 (< 0.8) | 0.74 (0.18 to 3.08) |
| Severe birth trauma‡ | 16 (0.2) | 35 (0.7) | 5.01 (2.75 to 9.15) | 19 (0.7) | 4.47 (2.27 to 8.80) | 9 (1.4) | 9.46 (4.11 to 21.8) |
| Respiratory distress§ | 302 (3.3) | 188 (4.0) | 1.25 (1.04 to 1.51) | 116 (4.2) | 1.29 (1.03 to 1.61) | 47 (7.1) | 2.29 (1.66 to 3.16) |
| Assisted ventilation¶ | 140 (1.5) | 63 (1.3) | 0.81 (0.60 to 1.10) | 37 (1.3) | 0.79 (0.54 to 1.14) | 12 (1.8) | 1.12 (0.61 to 2.05) |
| Fetal asphyxia | 23 (0.3) | 9 (0.2) | 0.77 (0.36 to 1.66)††† | < 5 (< 0.2) | 0.44 (0.13 to 1.45)††† | < 5 (< 0.8) | 1.22 (0.29 to 5.19)††† |
| Birth asphyxia | 19 (0.2) | 8 (0.2) | 0.83 (0.36 to 1.89)††† | 12 (0.4) | 2.12 (1.03 to 4.37)††† | < 5 (< 0.8) | 1.48 (0.34 to 6.36)††† |
| Intracranial hemorrhage due to hypoxia | < 5 (< 0.1) | < 5 (< 0.1) | 1.96 (0.28 to 13.9)††† | 8 (0.3) | 13.4 (2.85 to 63.2)††† | < 5 (< 0.8) | 14.1 (1.98 to 100)††† |
| Cardiac failure/dysrhythmia | 120 (1.3) | 67 (1.4) | 1.09 (0.80 to 1.47) | 47 (1.7) | 1.14 (0.80 to 1.62) | 18 (2.7) | 1.91 (1.15 to 3.18) |
| Severe cerebral morbidity** | 16 (0.2) | 18 (0.4) | 2.21 (1.13 to 4.34)††† | < 5 (< 0.2) | 0.42 (0.10 to 1.82)††† | < 5 (< 0.8) | 3.52 (1.17 to 10.6)††† |
| Birth trauma†† | 194 (2.1) | 304 (6.4) | 3.23 (2.68 to 3.88) | 307 (11.0) | 5.40 (4.47 to 6.52) | 100 (15.1) | 7.92 (6.11 to 10.3) |
| Meconium aspiration syndrome | 11 (0.1) | 9 (0.2) | 1.61 (0.67 to 3.88)††† | 10 (0.4) | 3.05 (1.29 to 7.19)††† | < 5 (< 0.8) | 2.56 (0.57 to 11.6)††† |
| Bacterial sepsis | 29 (0.3) | 28 (0.6) | 1.90 (1.13 to 3.20)††† | 6 (0.2) | 0.69 (0.29 to 1.67)††† | 0 (0.0) | – |
| Severe maternal morbidity/mortality | 153 (1.7) | 83 (1.8) | 1.19 (0.91 to 1.57) | 38 (1.4) | 0.87 (0.60 to 1.25) | 13 (2.0) | 1.26 (0.71 to 2.25) |
| Maternal death | 0 (0.0) | 0 (0.0) | – | 0 (0.0) | – | 0 (0.0) | – |
| Severe postpartum hemorrhage‡‡ | 97 (1.0) | 64 (1.4) | 1.51 (1.09 to 2.09) | 26 (0.9) | 0.92 (0.59 to 1.44) | 13 (2.0) | 2.00 (1.10 to 3.62) |
| Shock | < 5 (< 0.1) | < 5 (< 0.1) | 0.98 (0.18 to 5.36)††† | < 5 (< 0.2) | 0.84 (0.09 to 7.49)††† | 0 (0.0) | – |
| Sepsis | 20 (0.2) | 8 (0.2) | 0.78 (0.35 to 1.78)††† | 5 (0.2) | 0.84 (0.31 to 2.23)††† | 0 (0.0) | – |
| Cardiac complication§§ | 36 (0.4) | 7 (0.2) | 0.38 (0.17 to 0.86)††† | 6 (0.2) | 0.56 (0.23 to 1.32)††† | 0 (0.0) | – |
| Acute renal failure | < 5 (< 0.1) | < 5 (< 0.1) | – | < 5 (< 0.2) | – | 0 (0.0) | – |
| Obstetric embolism | 5 (0.1) | 0 (0.0) | – | < 5 (< 0.2) | – | 0 (0.0) | – |
| Evacuation incisional hematoma | < 5 (< 0.1) | < 5 (< 0.1) | – | 0 (0.0) | – | 0 (0.0) | – |
| Obstetric trauma¶¶ | 589 (6.3) | 1085 (22.9) | 4.51 (4.04 to 5.02) | 427 (15.4) | 2.70 (2.35 to 3.09) | 147 (22.2) | 4.24 (3.46 to 5.19) |
| Perineal laceration 3rd/4th degree | < 5 (< 0.1) | 888 (18.7) | – | 341 (12.3) | – | 135 (20.4) | – |
| Uterine incision extension | 268 (2.9) | 13 (0.3) | 0.11 (0.06 to 0.19) | 21 (0.8) | 0.29 (0.18 to 0.46) | < 5 (< 0.8) | 0.06 (0.01 to 0.40) |
| Postpartum infection*** | 126 (1.4) | 34 (0.7) | 0.54 (0.37 to 0.79) | 22 (0.8) | 0.60 (0.38 to 0.95) | 8 (1.2) | 0.87 (0.42 to 1.80) |
| Postpartum hemorrhage | 668 (7.2) | 792 (16.7) | 2.77 (2.48 to 3.10) | 323 (11.6) | 1.61 (1.39 to 1.86) | 111 (16.7) | 2.54 (2.03 to 3.17) |
Note: AOR = adjusted odds ratio, CI = confidence interval, CNS = central nervous system, PNS = peripheral nervous system.
↵* Adjusted odds ratios were estimated using logistic regression, with cesarean delivery as the reference group.
↵† All models were adjusted for maternal age, parity, birth weight, previous cesarean delivery, province and fiscal year.
↵‡ We included intracranial laceration and hemorrhage, skull fracture, severe injury to the CNS, severe injury to the PNS, long bone injury, subaponeurotic (subgaleal) hemorrhage, and injury to the liver and spleen.
↵§ We included respiratory distress syndrome, transient tachypnea of the newborn and other neonatal respiratory distress.
↵¶ We included resuscitation, chest compression, endotracheal respiratory assistance, mechanical respiratory assistance, forced oxygenation, intubation, mechanical ventilation and drugs for resuscitation.
↵** We included hypoxic ischemic encephalopathy, cerebral ischemia, cerebral irritability and cerebral depression.
↵†† We included intracranial hemorrhage/laceration, and injury to the CNS/PNS, scalp and skeleton.
↵‡‡ We included a combination of postpartum hemorrhage and transfusion codes.
↵§§ We included cardiac arrest, cardiac failure, myocardial infarction and pulmonary embolism.
↵¶¶ We included severe perineal lacerations (3rd/4th degree), cervical laceration, high vaginal laceration, injury to pelvic organ/joint, pelvic hematoma and extension of uterine incision.
↵*** We included sepsis, infection of obstetric surgical wound, infection of the genital tract following delivery, infection of the urinary tract following delivery, infections of the genitourinary tract following delivery, pyrexia of unknown origin following delivery and other specified puerperal infection.
↵††† Crude OR is reported because AOR was undefined owing to small numbers.