ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2017
Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Composite neonatal morbidity indicators using hospital discharge data: A systematic review.Paediatric and perinatal epidemiology · 2020Pooled it
- Perinatal outcome after vacuum assisted delivery with digital feedback on traction force; a randomised controlled study.BMC pregnancy and childbirth · 2021Trial
- IUGA International Guidelines on Obstetric Anal Sphincter Injuries.International urogynecology journal · 2026Article
- Long-term neurodevelopmental outcomes after vacuum-assisted delivery: A population-based cohort study.PLoS medicine · 2026Article
- Maternal and neonatal outcomes following emergency cesarean section or operative vaginal delivery for fetal distress in the second stage of labor.BMC pregnancy and childbirth · 2026Article
- Maternal morbidity following a trial of labor after cesarean birth: A scoping review of operative vaginal birth compared with cesarean birth in the second stage of labor.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Intrapartum Ultrasound in Vacuum Operative Delivery: A Comprehensive Review and Proposal of the Novel Ultrasound Flexion Point Method.Diagnostics (Basel, Switzerland) · 2026Review
- Article
- Long-term neurological morbidity among children delivered by vacuum extraction - a national cohort study.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia.SAGE open medicine · 2022Article
- Article
- Birth outcomes following cesarean delivery on maternal request: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2021Article
- Efficacy of intrauterine Bakri balloon tamponade combined with ascending uterine artery ligation on postpartum hemorrhage.American journal of translational research · 2021Article
- Article
- Substrates and Clearance Products of Fetal Adrenal Glucocorticoid Synthesis in Full-Term Human Umbilical Circulation.Journal of the Endocrine Society · 2020Article
- Still No Substantial Evidence to Use Prophylactic Antibiotic at Operative Vaginal Delivery: Systematic Review and Meta-Analysis.Obstetrics and gynecology international · 2020Review
- Ecological association between operative vaginal delivery and obstetric and birth trauma.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Article
- Taking a stand for operative vaginal delivery.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Article
- Mode of delivery after a previous cesarean birth, and associated maternal and neonatal morbidity.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2018Article
- Response to "Data limitations may affect conclusions in study of vaginal delivery at midpelvic station".CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017Article
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIncreased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery.
methodsWe studied all term singleton deliveries in Canada between 2003 and 2013, by attempted midpelvic operative vaginal or cesarean delivery with labour (with and without prolonged second stage). The primary outcomes were composite severe perinatal morbidity and mortality (e.g., convulsions, assisted ventilation, severe birth trauma and perinatal death), and composite severe maternal morbidity and mortality (e.g., severe postpartum hemorrhage, shock, sepsis, cardiac complications, acute renal failure and death).
resultsThe study population included 187 234 deliveries. Among women with dystocia and prolonged second stage of labour, midpelvic operative vaginal delivery was associated with higher rates of severe perinatal morbidity and mortality compared with cesarean delivery (forceps, adjusted odds ratio [AOR] 1.81, 95% confidence interval [CI] 1.24 to 2.64; vacuum, AOR 1.81, 95% CI 1.17 to 2.80; sequential instruments, AOR 3.19, 95% CI 1.73 to 5.88), especially with higher rates of severe birth trauma. Rates of severe maternal morbidity and mortality were not significantly different after operative vaginal delivery, although rates of obstetric trauma were higher (forceps, AOR 4.51, 95% CI 4.04 to 5.02; vacuum, AOR 2.70, 95% CI 2.35 to 3.09; sequential instruments, AOR 4.24, 95% CI 3.46 to 5.19). Among women with fetal distress, similar associations were seen for severe birth trauma and obstetric trauma, although vacuum was associated with lower rates of severe maternal morbidity and mortality (AOR 0.52, 95% CI 0.33 to 0.80). Associations tended to be stronger among women without a prolonged second stage.
interpretationMidpelvic operative vaginal delivery is associated with higher rates of severe birth trauma and obstetric trauma, whereas overall rates of severe perinatal and maternal morbidity and mortality vary by indication and operative instrument.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.