Introduction

Unsuccessful operative vaginal delivery (OVD) is associated with high rates of materno-fetal morbidity. We aimed to examine institutional rates of unsuccessful OVDs (uOVD) and compare them with successful OVD (sOVD) in order to identify factors to aid patient selection and education.

Methods

A 6-month retrospective cohort study was performed on all unsuccessful and successful OVDs in a tertiary level maternity hospital in the Republic of Ireland. Maternal demographics and obstetric factors were assessed to evaluate potential underlying risk factors for unsuccessful operative vaginal delivery versus successful vaginal delivery.

Results

There were 4,191 births during the study period with an OVD rate of 14.2% (n = 595) with 28 (4.7% of OVDs) being unsuccessful. Unsuccessful OVD were predominately nulliparous (25; 89.2%) with a mean maternal age of 30.1 years (range 20–42), with more than half (n = 15, 53.5%) being induced. The most common indication for induction was prolonged rupture of membranes (PROM) (n = 7, 25%) which was significantly different from the successful OVD group. A senior obstetrician was significantly more likely to be the primary operator in uOVD when compared to sOVD. (82.1 % V 54.1% p < 0.01). The majority of unsuccessful OVD were vacuum deliveries (n = 17; 60.7%), with a significantly higher mean birthweight when compared to successful OVD (3.695 kg V 3.483 kg; p < 0.01). Following an unsuccessful OVD, women were more likely to have a postpartum haemorrhage (64.2 % V 31.5% p < 0.01) and their infant was more likely to require admission to the neonatal intensive care unit (NICU) (32.1 % V 5.8% p < 0.01) when compared with successful OVD.

Conclusion

Risk factors for unsuccessful OVD were higher birth weight and induction of labour. There was a higher incidence of postpartum haemorrhage and NICU admission when compared with successful OVD.

中文翻译：

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阴道助产手术失败特征的回顾性队列研究

介绍

不成功的阴道手术分娩 (OVD) 与高母胎发病率相关。我们的目的是检查不成功的 OVD (uOVD) 的机构比率，并将它们与成功的 OVD (sOVD) 进行比较，以确定有助于患者选择和教育的因素。

方法

在爱尔兰共和国的一家三级妇产医院对所有不成功和成功的 OVD 进行了为期 6 个月的回顾性队列研究。评估了产妇人口统计学和产科因素，以评估阴道手术不成功与阴道分娩成功的潜在潜在危险因素。

结果

研究期间有 4,191 例分娩，OVD 率为 14.2%（n = 595），其中 28 例（占 OVD 的 4.7%）不成功。不成功的 OVD 主要是未经产的 (25; 89.2%)，平均产妇年龄为 30.1 岁（范围 20-42），超过一半 (n = 15, 53.5%) 被诱导。最常见的诱导适应症是长时间的膜破裂 (PROM)（n = 7, 25%），这与成功的 OVD 组有显着差异。与 sOVD 相比，高级产科医生更有可能成为 uOVD 的主要操作者。（82.1% V 54.1% p < 0.01）。大多数不成功的 OVD 是真空分娩（n = 17；60.7%），与成功的 OVD 相比，平均出生体重明显更高（3.695 kg V​​ 3.483 kg；p < 0.01）。OVD 失败后，

结论

OVD 不成功的危险因素是较高的出生体重和引产。与成功的 OVD 相比，产后出血和 NICU 入住的发生率更高。