A RANDOMIZED PROSPECTIVE-STUDY COMPARING THE NEW VACUUM EXTRACTOR POLICY WITH FORCEPS DELIVERY

Objective To compare assisted vaginal delivery by forceps with deliver y by vacuum extractor, where a new vacuum extractor policy was employe d which dictated the cup to be used in specific situations. Design Mul ticentre randomised controlled trial. Setting Four district general ho spitals in the West Midlands. Subjects Six hundred-seven women requiri ng assisted vaginal delivery, of whom 296 were allocated to vacuum ext ractor delivery and 311 to forceps. Main outcome measures Delivery suc cess rate. maternal perineal and vaginal injuries, maternal anaestheti c requirements, neonatal scalp and facial injuries. Results Of the vac uum extractor group, 85% were delivered by the allocated instrument co mpared to 90% in the forceps group (odds ratio (OR) 0.64; 95% confiden ce intervals (CI) 0.4-1.04). However, more women in the vacuum extract or 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 extrac tor group with other facial injuries. There were three babies in the f orceps group with unexplained neonatal convulsions. Conclusions Assist ed vaginal delivery using the new vacuum extractor policy is associate d with significantly less maternal trauma than with forceps. Further s tudies are required to assess neonatal morbidity adequately.