Instrumental delivery of the fetal head at the time of elective repeat cesarean: A randomized pilot study

We sought to ascertain whether the routine use of instruments, forceps or v acuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe For mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective stud y 44 women undergoing elective repeat cesarean were randomized to deliver b y Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared wit h regard to demographic variables and maternal and neonatal outcomes. Deliv eries were timed from entry into the uterus until full delivery of the infa nt. Maternal pain scores were assessed using a 10-cm visual analog scale. T here were no differences in demographic variables except that the M group h ad fewer women with up to two cesareans. A large percentage of women in eac h group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a tre nd for the F group to require a longer period of time for delivery (p = 0.0 61). Women in the V group reported significantly lower pain scores (p = 0.0 15). There were no serious neonatal injuries. The routine use of instrument s at the time of elective repeat cesarean delivery appears safe and effecti ve.