Sequential use of instruments at operative vaginal delivery: Is it safe?

OBJECTIVE: Our purpose was to examine maternal and neonatal outcomes in a c ohort of women who underwent delivery with the sequential use of instrument s. STUDY DESIGN: This retrospective case-control study included deliveries fro m May 1996 through March 1998. Charts of women who underwent delivery with the sequential use of instruments (vacuum first, then forceps, or vice vers a) were identified. Two control groups (1 forceps group, 1 vacuum group) we re randomly selected and matched for each case. Maternal and neonatal outco mes were abstracted and compared. RESULTS: There were 34 patients in each group. There were no significant de mographic differences. The vacuum group had lower rates of episiotomy (P =. 01) and deep perineal lacerations (P =.014), whereas these outcomes were si milar in the sequential and forceps groups. All other maternal outcomes wer e equivalent. There were no differences in any neonatal parameter except fo r superficial scalp trauma, which was more common in the vacuum group (P =. 002). CONCLUSION: We conclude that the prudent use of sequential instruments at o perative vaginal delivery did not engender higher rates of maternal or neon atal morbidity.