Maternal and neonatal outcome after failed ventouse delivery: comparison of forceps versus cesarean section.

OBJECTIVES: To compare the immediate maternal and neonatal morbidity in women delivered by forceps or cesarean section after failed ventouse delivery.

METHODS: Case notes of 400 consecutive successful ventouse deliveries compared with 342 failed ventouse deliveries, where delivery was subsequently achieved with either forceps (N = 247) or cesarean section (N = 95), which took place between October 1999 and May 2003, were reviewed.

RESULTS: Failed ventouse delivery was associated with an increased chance for fetal malposition (OR 3.7, 95% CI 2.6 - 5.3) and postpartum hemorrhage (OR 3.5, 95% CI 1.8 - 6.8). Compared to forceps after failed ventouse, cesarean section was associated with a higher prevalence of postpartum hemorrhage (OR 7.8, 95% CI 3.6 - 16.9) and fewer third degree perineal tears (p < 0.05). There were no significant differences between cesarean section and forceps delivery after failed ventouse for neonatal morbidity.

CONCLUSIONS: Failure of ventouse delivery is 3 - 4 times more likely with a fetal malposition and is associated with an increased risk of postpartum hemorrhage. While cesarean section increases the postpartum hemorrhage rate, forceps delivery is associated with increased likelihood of third degree perineal tears. The neonatal morbidity was comparable regardless of whether forceps or cesarean was used after failed ventouse.