Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries

The authors conducted a population-based historical cohort study in the Can adian province of Quebec to assess the maternal and infant outcomes associa ted with vacuum extraction and forceps deliveries. The study database conta ins information on 305,391 mother-infant dyads (linked by a common institut ional code and hospital chart number) for singleton live vaginal births wit h a nonbreech presentation at the gestational age of 37 or more completed w eeks and a birth weight between 2,500 acid 4,000 g during fiscal years 1991 /1992 to 1995/1996. Of the births, 31,015 were delivered by vacuum extracti on, and 18,727 were delivered by forceps. Compared with delivery by forceps , the adjusted risk ratios for third-/fourth-degree perineal laceration, in tracranial hemorrhage, subdural or cerebral hemorrhage, intraventricular he morrhage, subarachnoid hemorrhage, cephalhematoma, and neonatal in-hospital death were 0.48 (95% confidence interval: 0.45, 0.50), 1.28 (95% confidenc e interval: 0.73, 2.25), 0.97 (95% confidence interval: 0.49, 1.93), 0.99 ( 95% confidence interval: 0.16, 5.97), 5.44 (confidence interval: 1.26, 23.4 3), 2.02 (95% confidence interval: 1.89, 2.16), and 0.93 (95% confidence in terval: 0.32, 2.70), respectively. The authors conclude that vacuum extract ion causes less maternal trauma but may increase the risk of cephalhematoma and certain types of intracranial hemorrhage (e.g., subarachnoid hemorrhag e).