Trauma Rates High After Operative Vaginal Delivery in Canada

Rates of maternal trauma higher after forceps than vacuum delivery; rates vary by region

Trauma Rates High After Operative Vaginal Delivery in Canada
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MONDAY, Jan. 10, 2022 (HealthDay News) -- Rates of trauma following operative vaginal delivery (OVD) are high in Canada, and maternal trauma rates are higher with forceps than vacuum delivery, according to a study published online Jan. 10 in CMAJ, the journal of the Canadian Medical Association.

Giulia M. Muraca, Ph.D., M.P.H., from the University of British Columbia in Vancouver, Canada, and colleagues conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019 to examine incidence rates of trauma following OVD. The main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury).

The researchers found that 2.9 and 8.4 percent of the 1,326,191 deliveries were attempted forceps deliveries and attempted vacuum deliveries, respectively. Following forceps delivery, the maternal trauma rate was 25.3 percent and the neonatal trauma rate was 9.6 per 1,000 live births. Following vacuum delivery, the maternal and neonatal trauma rates, respectively, were 13.2 percent and 9.6 per 1,000 live births. After adjustment for confounders, maternal trauma rates remained higher after forceps than vacuum delivery (adjusted rate ratio, 1.70); the rates varied by region but not by level of obstetric care.

"Rates of maternal and neonatal trauma following OVD are high in Canada compared with other countries with similar rates of OVD, and are especially high in some provinces," the authors write. "These high rates call for a reassessment of the safety of OVD, not just in Canada, but in all settings where the rates of OVD and the opportunities for training in OVD are changing."

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