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Table 2 Comparison of impact of vacuum extractor versus forceps on stillbirths and perinatal mortality

From: Reducing stillbirths: interventions during labour

Source Location and Type of Study Intervention Stillbirths/Perinatal Outcomes
Reviews and meta-analyses
Johanson and Menon 1999 [7] USA, Denmark, Sweden, England, South Africa.
Meta-analysis (Cochrane). 7 RCTs included (N = 1800 women).
Assessed the effects of vacuum extraction vs. forceps on maternal and neonatal morbidity. PMR: OR = 0.80 (95% CI: 0.18–3.52) [NS].
[3/901 vs. 4/899 in vacuum vs. forceps group, respectively].
Johanson and Menon 2000 [8] Malaysia.
Cochrane review. 1 RCT included with death as outcome (N = 72 women).
To assess the effects of soft (intervention) vs. rigid vacuum extractor cups (control) on perineal injury, fetal scalp injury and success rate. Death: OR = 1.26 (95% CI: 0.08–20.85) [NS].
[1/32 vs. 1/40 in intervention and control groups, respectively].
Intervention studies
Mustafa and Mustafa 2002 [10] Pakistan (Multan). Nishtar Hospital.
RCT. Consecutive patients (N = 931), of which 50 were selected (N = 27 ventouse group, N = 23 forceps).
50/931 consecutive patients were randomly selected either to forceps delivery (Group I) or ventouse extraction (Group II).
Compared the effects of ventouse vs. forceps delivery on maternal and perinatal outcome. SBR: 0/27 vs. 1/23 in the vacuum and forceps groups, respectively.
Success rate: 26/27 (96.30%) vs. 22/23 (95.65%) in vacuum and forceps groups, respectively.
There was one failure in each category which was later on delivered by Caesarean section.
Weerasekera et al. 2002 [9] Sri Lanka. Tertiary care setting.
RCT. Women (N = 442) undergoing instrumental delivery in the second stage (N = 238 forceps group, N = 204 vacuum).
Compared the impact of forceps vs. vacuum delivery on the stillbirth rate. SBR or NMR: 1/238 vs. 1/204 in the forceps and vacuum groups, respectively; P > 0.05.
There was no significant difference in babies needing resuscitation at birth or admission to neonatal intensive care unit.
Observational studies
Broekhuizen et al. 1987 [11] USA. Tertiary care setting.
Retrospective study. N = 256 vacuum extractions, and N = 300 randomly chosen forceps deliveries were analyzed.
Compared the impact of the vacuum extraction vs. forceps deliveries. Death: one event in each group.
Gachiri et al. 1991 [13] Kenya (Nairobi). Kenyatta National Hospital.
Prospective study. Vacuum extractions (N = 167).
Assessed the fetal and maternal outcome among women undergoing vacuum extraction SBR: 6/167 (3.6%).
PMR: 8/167 (4.8%).
Mesleh 2002 [136] Saudi Arabia.
Retrospective review. Vaginal deliveries (N = 304) with instrument use (N = 258 ventouse group, N = 46 forceps).
Assessed the effects of vacuum vs. forceps deliveries on pregnancy outcomes. SBR: 1/258 vs. 0/46 in the forceps and ventouse groups, respectively.
The single stillbirth in the vacuum delivery group was due to intrapartum asphyxia and true knot in the umbilical cord.