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Master Thesis

Maternal and neonatal morbidity after attempted operative vaginal delivery according to the instrument type: a prospective study using a propensity score analysis

Abstract : Objective: to assess severe short-term maternal and neonatal morbidity and pelvic floor disorders at 6 months postpartum after attempted operative vaginal deliveries (OVD) according to type of instrument. Study design: prospective study of women with live singleton term fetuses in vertex presentation who underwent attempted OVD in a French tertiary-care university hospital from December 2008 through October 2013. We used multivariable logistic regression and propensity score methods to control for indication bias and compare outcomes associated with vacuum- or forceps-/spatula-assisted deliveries. Severe maternal and neonatal morbidity were composite primary endpoints. Symptoms of urinary incontinence (IU) and anal incontinence (AI) were assessed 6 months after delivery by validated self-administered questionnaires. Results: among 2,138 attempted OVDs, 30.7% (n=654) used vacuum, and 69.3% (n=1474) forceps/spatulas. Severe maternal morbidity occurred in 5.4% (n=35; 95%CI 3.8-7.4) of vacuum attempts and 10.5% (n=154; 95%CI 8.3-12.1) of forceps/spatula attempts (P<.001); and severe neonatal morbidity in 8.4% (n=55; 95%CI 6.4-10.8) and 10.2% (n=155; 95%CI 8.7-11.8) respectively (P=.2). Although forceps/spatula attempted OVD was significantly associated with more frequent severe maternal morbidity (aOR 1.99 95%CI 1.27-3.10) in multivariable logistic regression analysis, this association was no longer significant after propensity score matching (aOR 1.46 95%CI 0.72-2.95). Forceps/spatula attempted OVD was not significantly associated with more frequent severe neonatal morbidity after multivariable logistic regression or propensity score matching. Among the 934 women (43.9%) who responded to questionnaires at 6 months, the prevalence of symptoms of UI was 22.7% and of AI 22.0%, with no significant differences between the two groups. Conclusion: in singleton term pregnancies, neither severe short-term maternal or neonatal morbidity nor urinary or anal incontinence was more frequent after attempted OVD by forceps or spatulas than by vacuum after controlling for indication bias with a propensity score analysis.
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Submitted on : Monday, October 11, 2021 - 11:23:56 AM
Last modification on : Saturday, October 30, 2021 - 3:19:39 AM
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  • HAL Id : dumas-03372946, version 1



Alizée Froeliger. Maternal and neonatal morbidity after attempted operative vaginal delivery according to the instrument type: a prospective study using a propensity score analysis. Life Sciences [q-bio]. 2021. ⟨dumas-03372946⟩



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