Table 2.
Rate ratios expressing the association between operative vaginal delivery (OVD) versus caesarean delivery and severe perinatal and maternal morbidity/mortality among women with dystocia with adjustment using weighted multinomial propensity scores, British Columbia, 2004–2014
| Outcome | Caesarean delivery (n = 2405) | Attempted midcavity forceps (n = 1763) | Attempted midcavity vacuum (n = 690) | Attempted sequential midcavity OVD (n = 199) | ||||
|---|---|---|---|---|---|---|---|---|
| Rate (%) | ARR (95% CI) | Rate (%) | ARR (95% CI) | Rate (%) | ARR (95% CI) | Rate (%) | ARR (95% CI) | |
| Severe perinatal morbidity/mortality | 0.83 | Reference | 1.70 | 2.11 (1.46–3.07) | 2.17 | 2.17 (1.49–3.15) | 3.52 | 4.68 (3.33–6.58) |
| Severe birth trauma | 0.29 | Reference | 0.96 | 4.33 (2.31–8.11) | 1.01 | 3.16 (1.65–6.05) | <2.51 | 8.04 (4.41–14.7) |
| Assisted ventilation by endotracheal tube | 0.25 | Reference | 0.51 | 1.21 (0.61–2.37) | <0.72 | 1.36 (0.70–2.64) | <2.51 | 4.05 (2.31–7.10) |
| Respiratory distress | 1.49 | Reference | 3.63 | 1.68 (1.33–2.12) | 4.78 | 1.84 (1.46–2.31) | 4.52 | 1.99 (1.58–2.50) |
| Birth trauma | 1.16 | Reference | 4.03 | 4.18 (3.12–5.61) | 7.68 | 7.65 (5.78–10.1) | 11.6 | 10.2 (7.75–13.5) |
| Severe maternal morbidity | 0.79 | Reference | 1.19 | 1.57 (1.05–2.36) | 1.45 | 2.29 (1.57–3.36) | <2.51 | 1.48 (0.98–2.25) |
| Severe postpartum haemorrhage | 0.50 | Reference | 0.96 | 2.46 (1.43–4.25) | 1.30 | 4.17 (2.50–6.97) | <2.51 | 1.78 (1.00–3.20) |
| Postpartum haemorrhage | 4.62 | Reference | 21.2 | 4.39 (3.80–5.07) | 13.9 | 3.38 (2.92–3.93) | 17.6 | 3.91 (3.38–4.53) |
| Obstetric trauma | 3.83 | Reference | 26.4 | 8.48 (7.22–9.96) | 11.6 | 3.61 (3.03–4.29) | 22.6 | 6.90 (5.86–8.13) |
| Severe perineal laceration (third/fourth degree)a | 0.00 | Reference | 23.0 (21.1–25.0) | 10.3 (8.24–12.8) | 21.1 (16.0–27.3) | |||
Results adjusted for maternal age, parity, previous caesarean delivery, pre‐pregnancy weight, position of fetal head at delivery, birthweight, income quintile, and year of delivery.
a
Rate (%) and 95% CI provided for severe perineal lacerations as relative estimates could not be estimated due to small numbers (0.00%) in the reference group.