Maternal and Neonatal Morbidity with Sequential Instrumental Delivery as Compared to the Single-use at Operative Vaginal Delivery: A Retrospective Study

Objective: To evaluate the maternal and neonatal morbidity associated with sequential instrumental delivery compared to single instrument use.Materials and methods: This retrospective study was conducted in a tertiary center in South India, including 280 women who had undergone instrumental vaginal delivery.The study population was divided into three groups depending on the type of instrument used.The sequential use of both vacuum and forceps instruments group had 40 cases, the forceps and vacuum delivery group had 120 patients each.Case records were retrieved consecutively till the targeted sample was achieved.Data on maternal and neonatal outcomes were collected and compared.Results: Most study participants were primigravida, and fetal distress was the commonest indication for instrumentation in all three groups.Along with body mass index (p = 0.001), gestational age (p = 0.04), station of the fetal head (p = 0.02), and degree of caput (p 0.001), statistically significant differences were found among the three groups.Maternal birth trauma, need for blood transfusion (p = 0.022), neonatal injury (p = 0.005), and requirement for intensive care unit monitoring (p = 0.001) were more frequently noted in the sequential instrument group as compared to delivery conducted by a single instrument. Conclusion:Our study observed that sequential use of vacuum and forceps instruments is likely associated with a higher risk of injury to both the newborn and the mother.Therefore, their use should be carefully considered and carried out only by skilled healthcare professionals in an appropriate medical setting.