Comparison of maternal and fetal effects of vacuum extraction with forceps or cesarean deliveries.

Results of 90 vacuum extraction (VE) deliveries were compared with effects on the mother and fetus of forceps delivery or cesarean section. Forceps delivery increased the incidence of birth canal trauma threefold and the incidence of anemia sevenfold (18% for VE versus 48% for forceps delivery, and 4 versus 30%, respectively) (P less than or equal to .001). When cesarean section was the alternative operation, the incidence of blood loss was significantly increased (72%, versus 18% with VE), as was febrile morbidity (48%, versus 6% with VE) (P less than or equal to .001). Hospitalization time and costs in the present and future for cesarean section deliveries are markedly higher than for VE. Maternal requirements for anesthesia are markedly reduced with VE because of the gentleness of the operation. A failed trial of VE in 7 patients did not constitute any greater hazard to the mother than initial management by cesarean section. However, babies born by cesarean section after failed VE had a slightly lower Apgar score at 1 minute (P less than or equal to .05) but not at 5 minutes, as compared with babies born by cesarean section attempted initially. Otherwise, Apgar scores of infants born by VE did not differ from those of infants delivered by forceps or cesarean section. Infants delivered by VE had a higher incidence of transient cosmetic deformations, including "chignon" and cephalhematoma, whereas infants delivered by forceps had forceps marks and facial lacerations more frequently. Neither perinatal mortality nor serious traumatic complications were attributable to VE, due to its judicious use for a limited time of approximately 15 minutes.