randomized comparative study on the effect of the use of vacuum extraction with metal or silastic cups versus outlet forceps delivery in the second stage management of nulliparas on maternal and neonatal complications

ABSTRACT

A prospective study was designed to determine the effectiveness and safety of different outlet instrumental deliveries. One hundred and fifty two nulliparas women for whom instrumental delivery was decided and had the criteria for low forceps delivery, were randomized to low forceps, vacuum extraction with the conventional metal cup or the silastic rubber cup. Forceps delivery had the lowest significant failure rate [9.8%] compared to metal cup and silc-cup deliveries [17% and 18.5%]. However, there was a significant greater incidence of maternal soft tissue injuries in the forceps group [45%] compared to 16.7% in the silc-cup and 23.4% of the metal vacuum extractors. Neonatal scalp injuries were significantly higher in the forceps group [47%] compared to silc-cup group [20.4%], while the difference was not significant as regards the metal cup group [40%]. There was a significant increase in neonatal morbidity for the metal cup group compared with silc-cup delivery, specially scalp trauma and cephalohematomata. There were no significant differences in the Apgar score, neonatal jaundice, retinal hemorrhages, intracranial hemorrhage and umbilical artery, pH between the metal cup, the silc- cup, the vacuum extractors and forceps groups. Based on these findings, the vacuum extractor is effective instrument outlet delivery with less maternal morbidity compared to forceps delivery. The silicon cup is preferred to metal cup due to less neonatal morbidity. Although the forceps is the most effective instruments, but due to the associated maternal morbidity, its use is limited to selected cases as preterm and uncooperative parturients