Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature

详细信息    查看全文

• 作者：Andrea Dall&rsquo ; Asta^a ; ^{andrea.dallasta1@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Tullio Ghi^a ; ^{tullio.ghi@unipr.it" class="auth_mail" title="E-mail the corresponding author} ; ^{tullioghi@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Giuseppe Pedrazzi^b ; ^{giuseppe.pedrazzi@unipr.it" class="auth_mail" title="E-mail the corresponding author} ; Tiziana Frusca^a ; ^{fruscatiziana@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Shoulder dystocia ; Operative delivery ; Vacuum extractor ; Forceps ; Labor complication
• 刊名：European Journal of Obstetrics & Gynecology and Reproductive Biology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：204
• 期：Complete
• 页码：62-68
• 全文大小：941 K

文摘

Vacuum extractor has been increasingly used over the last decades and is acknowledged as a risk factor for shoulder dystocia (SD). In this meta-analysis we assess the actual risk of SD following a vacuum delivery compared to spontaneous vaginal delivery (SVD) and forceps.

Materials and methods

Systematic literature search (English literature only) on MEDLINE, EMBASE, ScienceDirect, the Cochrane library and rials.gov">ClinicalTrials.gov conducted up to May 2015. Key search terms included: Operative/Vacuum/Forceps delivery [Mesh] and shoulder dystocia and subheadings. 2 stage-process study selection. We included only studies where data concerning the occurrence of SD following operative vaginal delivery were reported as adjusted odds ratio (AOR) and no significant difference in confounding factors for SD was recorded. Included trials clustered according to the delivery mode (1) vacuum vs. SVD, (2) forceps vs. vacuum. Methodological quality of each study evaluated with the Newcastle–Ottawa System (NOS).

Results

87 potentially relevant papers. After applying inclusion and exclusion criteria only 7 were selected for the meta-analysis. Vacuum delivery appeared associated with a higher risk of SD than SVD in both fixed and random model (OR 2.87 and 2.98 respectively). No difference in the rate of SD was found between vacuum and forceps (p > 0.05).

Conclusion

Vacuum extractor carries an increased risk of SD compared with spontaneous vaginal delivery whereas the occurrence of SD does not seem to vary following vacuum or forceps.