135: Pregnancy outcome and mode of delivery following a previous operative vaginal delivery

Objective We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Study Design Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital. Results Total 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76–2.65), nulliparity (OR = 2.06, 95% CI: 1.59–2.66), epidural (OR = 2.05, 95% CI: 1.19–3.56), maternal indication (OR = 1.53, 95% CI 1.16–2.02), older maternal age (OR 1.18, 95% CI 1.06–1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01–1.20 per hour).Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23–11.20), a perinatologist (OR = 2.51, 95% CI: 1.09–5.78), longer second stage (OR = 1.79, 95% CI: 1.65–1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01–1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01–1.04 per hour). Conclusion Patient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.

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Comment on “Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs Cesarean Section”

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2016.03.373 ◽

2016 ◽

Vol 13 (7) ◽

pp. 1142-1143 ◽

Cited By ~ 1

Author(s):

Antonio Simone Laganà ◽

Alessio Platania ◽

Salvatore Butticè ◽

Salvatore Giovanni Vitale

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Sexual Functioning ◽

Mode Of Delivery ◽

Spontaneous Vaginal Delivery ◽

Operative Vaginal Delivery

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Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs Cesarean Section

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2016.01.004 ◽

2016 ◽

Vol 13 (3) ◽

pp. 393-401 ◽

Cited By ~ 28

Author(s):

Giussy Barbara ◽

Paola Pifarotti ◽

Federica Facchin ◽

Ivan Cortinovis ◽

Dhohua Dridi ◽

...

Keyword(s):

Cesarean Section ◽

Vaginal Delivery ◽

Sexual Functioning ◽

Mode Of Delivery ◽

Spontaneous Vaginal Delivery ◽

Operative Vaginal Delivery

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A Prospective, Population-Based Study of Trends in Operative Vaginal Delivery Compared to Cesarean Delivery Rates in Low- and Middle-Income Countries, 2010–2016

American Journal of Perinatology ◽

10.1055/s-0038-1673656 ◽

2018 ◽

Vol 36 (07) ◽

pp. 730-736 ◽

Cited By ~ 3

Author(s):

Margo S. Harrison ◽

Sarah Saleem ◽

Sumera Ali ◽

Omrana Pasha ◽

Elwyn Chomba ◽

...

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

Hospital Setting ◽

Population Based ◽

Population Based Study ◽

Middle Income ◽

Middle Income Countries ◽

Operative Vaginal Delivery ◽

Low And Middle Income

Objective Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time, across sites. Study Design A prospective population-based study, including home and facility births among women enrolled from 2010 to 2016, was performed in communities in Argentina, Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Women were enrolled during pregnancy and delivery outcome data were collected. Results We analyzed 354,287 women; 4,119 (1.2%) underwent an operative vaginal delivery and 45,032 (11.2%) delivered by cesarean. Across all sites with data for 7 years, rates of operative vaginal delivery decreased from 1.6 to 0.3%, while cesarean delivery increased from 6.4 to 14.4%. Similar trends were seen when individual country data were analyzed. Operative vaginal delivery rates decreased in both hospitals and clinics, except in the hospital setting at one of the Indian sites. Conclusion In low- and middle-income countries, operative vaginal delivery is becoming less utilized while cesarean delivery is becoming an increasingly common mode of delivery.

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Pregnancy Outcome after Vaginal Natural Orifice Transluminal Endoscopic Surgery, a First Retrospective Observational Cohort Study

Gynecologic and Obstetric Investigation ◽

10.1159/000517834 ◽

2021 ◽

pp. 1-6

Author(s):

Ine Tavano ◽

Susanne Housmans ◽

Jan Bosteels ◽

Jan Baekelandt

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

Pregnancy Outcome ◽

Vaginal Delivery ◽

Endoscopic Surgery ◽

Mode Of Delivery ◽

Observational Cohort Study ◽

Natural Orifice ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

Study Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimal invasive surgical technique allowing a variety of gynecological procedures. The current literature describes improved patient comfort, improved better cosmetic results, and reduced operation time. This is a first study to assess pregnancy outcome after fertility-preserving vNOTES procedures. Design/Participants/Materials/Setting/Methods: We performed a retrospective observational cohort study including 125 patients under 43 years that underwent fertility-preserving vNOTES over a 5-year period (2014–2019). The gynecological surgical procedures included were vNOTES myomectomy, vNOTES salpingectomy for ectopic pregnancy, vNOTES unilateral adnexectomy, and vNOTES cystectomy. A total of 26 pregnancies in 21 cases were observed, with deliveries between 2015 and 2020. Results: Retrospective analysis in this patient group showed that 18 pregnancies were diagnosed within 1 year after vNOTES (85.7%). Mean interval between surgery and pregnancy was 6 months. Fertility treatment was performed in 28.6%. In the 26 observed pregnancies, no vNOTES-related complications were observed and delivery was at term in all cases. Mode of delivery was a vaginal delivery in twenty cases (76.9% of total) of which 2 cases vacuum assisted (7.7%) and a Caesarean section in 6 cases (23.1% of total). Two cases of trial of labor after Caesarean are described after vNOTES surgery, both ended in an uncomplicated vaginal delivery. In case of vaginal delivery, the perineum was intact in 15%, a mediolateral episiotomy was performed in 50 and 35% a grade 1–2 perineal rupture was described. No grade 3–4 perineal ruptures are described. Limitations: A limitation of this study is the retrospective design which does not correct for confounding factors. Further larger multicenter studies are needed to validate these data. Conclusions: This is the first study describing pregnancy outcome after fertility-preserving vNOTES procedures. vNOTES did not affect the mode of delivery or cause pregnancy-related complications. vNOTES did not increase the risk of extensive perineal tears during vaginal delivery. These preliminary data show no adverse events when vNOTES is performed in women of reproductive age. Posterior colpotomy as performed in all vNOTES procedures is by itself not an indication for an elective Caesarean section.

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