Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes

Emily S. Miller, Yinglei Lai, Jennifer Bailit, Uma M. Reddy, Ronald J. Wapner, Michael W. Varner, John M. Thorp, Kenneth J. Leveno, Steve N. Caritis, Mona Prasad, Alan T.N. Tita, George R. Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa, W. Grobman, G. Mallett, M. Ramos-Brinson, A. RoyL. Stein, P. Campbell, C. Collins, N. Jackson, M. Dinsmoor, J. Senka, K. Paychek, A. Peaceman, M. Talucci, M. Zylfijaj, Z. Reid, R. Leed, J. Benson, S. Forester, C. Kitto, S. Davis, M. Falk, C. Perez, K. Hill, A. Sowles, J. Postma, S. Alexander, G. Andersen, V. Scott, V. Morby, K. Jolley, J. Miller, B. Berg, K. Dorman, J. Mitchell, E. Kaluta, K. Clark, K. Spicer, S. Timlin, K. Wilson, L. Moseley, M. Santillan, J. Price, K. Buentipo, V. Bludau, T. Thomas, L. Fay, C. Melton, J. Kingsbery, R. Benezue, H. Simhan, M. Bickus, D. Fischer, T. Kamon, D. Deangelis, B. Mercer, C. Milluzzi, W. Dalton, T. Dotson, P. McDonald, C. Brezine, A. McGrail, C. Latimer, L. Guzzo, F. Johnson, L. Gerwig, S. Fyffe, D. Loux, S. Frantz, D. Cline, S. Wylie, J. Iams, M. Wallace, A. Northen, J. Grant, C. Colquitt, W. Andrews, J. Moss, A. Salazar, A. Acosta, G. Hankins, N. Hauff, L. Palmer, P. Lockhart, D. Driscoll, L. Wynn, C. Sudz, D. Dengate, C. Girard, S. Field, P. Breault, F. Smith, N. Annunziata, D. Allard, J. Silva, M. Gamage, J. Hunt, J. Tillinghast, N. Corcoran, M. Jimenez, F. Ortiz, P. Givens, B. Rech, C. Moran, M. Hutchinson, Z. Spears, C. Carreno, B. Heaps, G. Zamora, J. Seguin, M. Rincon, J. Snyder, C. Farrar, E. Lairson, C. Bonino, W. Smith, K. Beach, S. Van Dyke, S. Butcher, E. Thom, M. Rice, Y. Zhao, P. McGee, V. Momirova, R. Palugod, B. Reamer, M. Larsen, C. Spong, S. Tolivaisa, J. P. Vandorsten

Research output: Contribution to journalArticlepeer-review


Objective: This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes. Study Design: This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls. Results: Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application. Conclusion: The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls.

Original languageEnglish (US)
Pages (from-to)503-510
Number of pages8
JournalAmerican journal of perinatology
Issue number5
StatePublished - Apr 1 2020


  • duration
  • forceps
  • operative vaginal delivery
  • pop-offs
  • pulls
  • vacuum

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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