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Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries

Johnson, Jennifer H. MD; Figueroa, Reinaldo MD; Garry, David DO; Elimian, Andrew MD; Maulik, Dev MD, PhD

doi: 10.1097/01.AOG.0000114985.22844.6d
Original Research

OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries.

METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliveries that occurred from January 1, 1998, to August 30, 1999, at Winthrop-University Hospital. Maternal demographics and delivery characteristics were recorded. Maternal outcomes, such as use of episiotomy and presence of lacerations, were studied. Neonatal outcomes evaluated were Apgar scores, neonatal intensive care unit admissions, cephalohematomas, instrument marks and bruising, and caput and molding.

RESULTS: Of 508 operative vaginal deliveries, 200 were forceps and 308 were vacuum assisted. Forceps were used more often than vacuum for prolonged second stage of labor (P = .001). There was a higher rate of epidural (P = .02) and pudendal (P < .001) anesthesia, episiotomies (P = .01), maternal third- and fourth-degree perineal (P < .001) and vaginal lacerations (P = .004) with the use of forceps, whereas periurethral lacerations were more common in vacuum-assisted (P = .026) deliveries. More instrument marks and bruising (P < .001) were found in the neonates delivered by forceps, whereas there was a greater incidence of cephalohematomas (P = .03) and caput and molding (P < .001) in the neonates delivered with vacuum. Multivariable logistic regression analysis showed that forceps use was associated with an increase in major perineal and vaginal tears (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.27, 2.69; P = .001), an increase in instrument marks and bruising (OR 4.63; 95% CI 2.90, 7.41; P < .001) and a decrease in cephalohematomas (OR 0.49; 95% CI 0.29, 0.83; P = .007) compared with the vacuum.

CONCLUSIONS: Maternal injuries are more common with the use of forceps. Neonates delivered with forceps have more facial injuries, whereas neonates delivered with vacuum have more cephalohematomas.


Forceps use causes more third- and fourth-degree perineal and vaginal laceration whereas vacuum-assisted deliveries cause more periurethral lacerations.

From the Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola, New York, and the State University of New York at Stony Brook.

Received November 24, 2003. Received in revised form November 25, 2003. Accepted December 4, 2003.

Address reprint requests to: Dr. Reinaldo Figueroa, Department of Obstetrics and Gynecology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501; e-mail:

© 2004 The American College of Obstetricians and Gynecologists