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Saturday, January 18, 2014

Trailers (72): Obstetrician forceps volume and outcomes

Miller, et al. Association between obstetrician forceps volume and maternal and neonatal outcomes

Why should you read about this topic?

To determine if frequency of forceps deliveries has become so low that the rate of adverse outcomes is affected.

What were the authors trying to do?

Estimate the association between obstetrician forceps delivery volume and severe perineal lacerations and adverse neonatal outcomes

Who participated and in what setting?

Women (N=2369) at least 18 years of age delivering or attempting delivery by forceps at Northwestern Memorial Hospital between 2008-2012

What was the study design?

Retrospective cohort

What were the main outcome measures?

Severe (3rd or 4th degree) perineal laceration and a composite adverse neonatal outcome

What were the results?

There was no significant relationship between volume quartile and severe perineal laceration.  Multivariable analysis showed no association between volume quartile and composite neonatal outcome.

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strengths:  large number of deliveries.     Weaknesses: retrospective study; other vaginal, cervical, and uterine lacerations not evaluated.

What does the study contribute for your practice?

Under current conditions there is no relationship between obstetrician forceps volume or  years of experience and severe perineal lacerations or neonatal adverse outcome.