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dc.contributor.authorAiken, Abigail Ren
dc.contributor.authorAiken, Catherineen
dc.contributor.authorAlberry, Medhat Sen
dc.contributor.authorBrockelsby, Jeremy Cen
dc.contributor.authorScott, James Gen
dc.date.accessioned2014-10-17T08:14:54Z
dc.date.available2014-10-17T08:14:54Z
dc.date.issued2014-10-18en
dc.identifier.citationAmerican Journal of Obstetrics and Gynecology 212 (3): 355.e1–355.e7. doi: 10.1016/j.ajog.2014.10.023.en
dc.identifier.issn0002-9378
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/246184
dc.description.abstractObjective: To determine the factors associated with selection of rotational instrumental versus cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments versus cesarean section. Study Design: We conducted a retrospective cohort study over a 5-year period in a tertiary UK obstetrics center. 868 women with vertex-presenting, single, live-born infants at term with persistent malposition in the second stage of labor were included. Propensity-score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean section. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse versus cesarean section, adjusting for propensity scores. Results: Increased likelihood of rotational instrumental delivery was associated with lower maternal age (OR= 0.95 p<0.01), lower BMI (OR=0.94 p<0.001), lower birth-weight (OR=0.95 p<0.01), no evidence of fetal compromise at the time of delivery (OR=0.31 p<0.001), delivery during the daytime (OR= 1.45, P<0.05), and delivery by a more experienced obstetrician (OR=7.21 p<0.001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8± 48ml p<0.001). Conclusions: Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean section rates.
dc.description.sponsorshipDuring data analysis, A.R.A. was supported by an NICHD Predoctoral Fellowship under grant number F31HD079182 and by grant R24HD042849, awarded to the Population Research Center at The University of Texas at Austin. She is currently supported by grant R24HD047879 for Population Research at Princeton University. J.G.S. is partially funded by a CAREER grant from the National Science Foundation (DMS-1255187).
dc.languageEnglishen
dc.language.isoenen
dc.publisherElsevier
dc.subjectcaesarean sectionen
dc.subjectoperative vaginal deliveryen
dc.subjectfetal malpositionen
dc.subjectdeliveryen
dc.subjectintra-partum careen
dc.titleManagement of fetal malposition in the second stage of labor: a propensity score analysisen
dc.typeArticle
dc.description.versionThis is the accepted version. It will be embargoed until 12 months after the final version is published by Elsevier. The final version is available from Elsevier at http://www.sciencedirect.com/science/article/pii/S0002937814010783en
prism.endingPage355.e7
prism.publicationDate2014en
prism.publicationNameAmerican Journal of Obstetrics and Gynecologyen
prism.startingPage355.e1
prism.volume212en
dc.rioxxterms.funderNICHD
dc.rioxxterms.funderNSF
dc.rioxxterms.projectidF31HD079182
dc.rioxxterms.projectidR24HD042849
dc.rioxxterms.projectidR24HD047879
dc.rioxxterms.projectidDMS-1255187
dcterms.dateAccepted2014-10-15en
rioxxterms.versionofrecord10.1016/j.ajog.2014.10.023en
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2014-10-18en
dc.contributor.orcidAiken, Catherine [0000-0002-6510-5626]
dc.identifier.eissn1097-6868
rioxxterms.typeJournal Article/Reviewen
rioxxterms.freetoread.startdate2015-10-18


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