Early maternal and neonatal morbidity associated with operative delivery in second stage of labour: a cohort study

Background A frequent dilemma for obstetricians is how to keep morbidity to a minimum when faced with arrested progress at full dilatation of the cerv ix. Our aim was to examine maternal and neonatal morbidity associated with vaginal instrumental delivery in theatre and caesarean section, at full dil atation. Methods We did a prospective cohort study of 393 women, who had term, singl eton, liveborn, cephalic pregnancies requiring operative delivery in theatr e at full dilatation for 1 year. Findings Factors increasing the likelihood of caesarean section included ma ternal body-mass index greater than 30 (adjusted odds ratio 2.4, 95% CI 1.2 -4.9), neonatal birthweight greater than 4.0 kg (2.3, 1.3-3.8), and occipit oposterior position (2.5, 1.6-3.9). Women undergoing caesarean section were more likely to have a major haemorrhage (>1 L; 2.8, 1.1-7.6) and extended hospital stay (greater than or equal to6 days; 3.5, 1.6-7.6) than those wit h vaginal delivery. Babies delivered by caesarean section were more likely to require admission for intensive care (2.6, 1.2-6.0) but less likely to h ave trauma (0.4, 0.2-0.7) than babies delivered by forceps. Overall neonata l morbidity was low, but a few babies in each group had serious complicatio ns (serious trauma, eight vs three; sepsis, six vs 13; and jaundice, ten vs 12 after vaginal delivery and caesarean section, respectively). Major haem orrhage was less likely after delivery by a skilled obstetrician (0.5, 0.3- 0.9). Interpretation The data lend support to an aim to deliver women vaginally, unless there are clear signs of cephalopelvic disproportion, and underline the importance of skilled obstetricians supervising complex operative deliv eries.