What happens when vacuum extraction fails?

Objective: To compare maternal and neonatal outcomes of forceps delivery or cesarean section (CS) following failed vacuum extraction. Methods: A retrospective cohort study of all women who underwent forceps delivery and/or CS after failed vacuum extraction in 1993-2006 was conducted. Cases were identified by searching the computerized delivery discharge database. All files were reviewed and those who underwent CS were compared to those who underwent forceps delivery. Results: Compared to CS (n = 112), forceps delivery (n = 328) was associated with a significantly higher risk of adverse composite maternal outcome (P = 0.001), third/fourth-degree perineal tears (P = 0.005), prolonged hospitalization (P = 0.03), and cephalohematoma (P = 0.04). In the forceps group, the risk was increased by nulliparity, occipito-posterior position, S + 1 station, and pre-pregnancy maternal obesity; in the cesarean group, higher maternal risk was associated with delivery in the evening/night and S + 2 or lower. In cases of nonreassuring fetal heart rate, composite neonatal outcome was worse after CS. Conclusion: Forceps delivery after failed vacuum extraction may be associated with greater short-term maternal morbidity than CS, although it might be associated with better perinatal outcome in cases of nonreassuring fetal heart rate.