UNIVERSITY OF CEBU – BANILAD

COLLEGE OF NURSING

RELATED READING

Name: Cugay, Jay-an Ainsley A. Date: May 6, 2023

Year and Section: BSN 2I Clinical Instructor: Ms. Joanne Marie Valle

Title of Article: Severe Maternal and Neonatal Morbidity in Attempted Operative Vaginal Delivery

Maternal morbidity refers to maternal health problems related to pregnancy and giving birth. It can
occur during pregnancy, during delivery, and after a pregnancy ends. Maternal morbidity includes a range
of different health conditions. Some of them start during pregnancy and last only a short time, while others
do not develop until years after a pregnancy and continue throughout the woman’s life. Neonatal
morbidity refers to the risk of death during the newborn period – the first 28 days of life. The major causes
of neonatal morbidity (prematurity and birth defects) generally occur in pregnancies free of antecedent
complications. Having a previous birth with an anomaly or a previous preterm birth both raise the maternal
risk for recurrence of the condition.

Operative vaginal delivery involves application of forceps or a vacuum extractor to the fetal head
to assist during the 2nd stage of labor and facilitate delivery. Operative vaginal delivery is a critical tool
in reducing primary cesarean delivery, but declining operative vaginal delivery rates and concerns about
provider skill necessitate a clear understanding of risks. These risks are ambiguous because most studies
compare outcomes of operative vaginal delivery with that of spontaneous vaginal delivery rather than
outcomes of cesarean delivery in the second stage of labor, which is usually the realistic alternative.
Before starting an operative vaginal delivery, the clinician should confirm complete cervical dilation,
confirm an engaged fetal vertex at station +2 or lower, confirm rupture of membranes, confirm that fetal
position is compatible with operative vaginal delivery, drain the maternal bladder, clinically assess pelvic
dimensions (clinical pelvimetry) to determine whether the pelvis is adequate. Vacuum extraction is
typically considered contraindicated in preterm pregnancies of < 34 weeks because risk of
intraventricular hemorrhage is increased.

Operative vaginal delivery infrequently failed and was associated with a 214% increase in severe
maternal morbidity and a 78% increase in severe unexpected neonatal morbidity; furthermore, combined
operative vaginal deliveries were major contributors to this, as all combined operative vaginal deliveries
failed. Optimization of operative vaginal delivery success rates through means such as improved patient
selection, enhanced provider skill, and discussions against combined operative vaginal delivery could
reduce maternal and neonatal complications. Operative vaginal delivery with forceps or vacuum is safe
and effective where the overall risk of neonatal injuries is low and the choice of whether to use vacuum
or forceps is defined by clinical circumstances and operator preference.

In my perspective, the introduction of operative vaginal delivery in facilitating deliveries to reduce

cesarean deliveries have both the advantage and disadvantages. One of its advantages is, yes, it can
primarily reduce the chances of cesarean deliveries. However, operative vaginal delivery involves the
use of forceps or vacuum extractor to the fetal head. Maternal complications can arise and these can be:
increased rates of anal sphincter injuries, anal incontinence, 3 rd and 4th degree perineal tears, and sexual
and pelvic floor dysfunction. Neonatal complications can be: laceration, cephalohematoma, intracranial
and retinal hemorrhage, hyperbilirubinemia and other long-term complications to the neonate. Thus,
having an operative vaginal delivery requires a skilled professional to achieve a smooth and safe delivery
with lower risk of complication.

References:

Moldenhauer, J. S. (2022). Abnormalities and Complications of Labor and Delivery: Operative Vaginal Delivery. MSD
Manuals Professional Version. https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-and-
complications-of-labor-and-delivery/operative-vaginal-delivery\
Muraca, G. M, et al. (2022). Maternal and neonatal trauma following operative vaginal delivery. CMAJ, 194(1), E1-12.
https://doi.org/10.1503/cmaj.210841
National Institutes of Health. (2020). Maternal Morbidity and Mortality: What are examples and causes of maternal
morbidity and mortality? NICHD – Eunice Kennedy Shriver National Institutes of Health and Human Development.
https://www.nichd.nih.gov/health/topics/maternal-morbidity-mortality/conditioninfo/causes
Panelli, D., et al. (2021). Severe maternal and neonatal morbidity after attempted operative vaginal delivery. NIH –
National Library of Medicine. https://doi.org/10.1016/j.ajogmf.2021.100339