{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:22:43Z","timestamp":1787160163852,"version":"build-2736575974"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,8,21]],"date-time":"2017-08-21T00:00:00Z","timestamp":1503273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["APR\u2010126338"],"award-info":[{"award-number":["APR\u2010126338"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["MAH\u201015445"],"award-info":[{"award-number":["MAH\u201015445"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,5]]},"abstract":"\n Objective<\/jats:title>\n To quantify severe perinatal and maternal morbidity\/mortality associated with midcavity operative vaginal delivery compared with caesarean delivery.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Population\u2010based, retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n British Columbia, Canada.<\/jats:p>\n <\/jats:sec>\n \n Population<\/jats:title>\n \n Term, singleton deliveries (2004\u20132014) by attempted midcavity operative vaginal delivery or caesarean delivery in the second stage of labour, stratified by indication for operative delivery (\n n<\/jats:italic>\n \u00a0=\u00a010\u00a0901 deliveries; 5057 indicated for dystocia, 5844 for fetal distress).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Multinomial propensity scores and mulitvariable log\u2010binomial regression models were used to estimate adjusted rate ratios (\n ARR<\/jats:styled-content>\n ) and 95% confidence intervals (95%\n CI<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Composite severe perinatal morbidity\/mortality (e.g. convulsions, severe birth trauma and perinatal death) and severe maternal morbidity (e.g. severe postpartum haemorrhage, shock, sepsis and cardiac complications).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among deliveries with dystocia, attempted midcavity operative vaginal delivery was associated with higher rates of severe perinatal morbidity\/mortality compared with caesarean delivery (forceps\n ARR<\/jats:styled-content>\n 2.11, 95%\n CI<\/jats:styled-content>\n 1.46\u20133.07; vacuum\n ARR<\/jats:styled-content>\n 2.71, 95%\n CI<\/jats:styled-content>\n 1.49\u20133.15; sequential\n ARR<\/jats:styled-content>\n 4.68, 95%\n CI<\/jats:styled-content>\n 3.33\u20136.58). Rates of severe maternal morbidity\/mortality were also higher following midcavity operative vaginal delivery (forceps\n ARR<\/jats:styled-content>\n 1.57, 95%\n CI<\/jats:styled-content>\n 1.05\u20132.36; vacuum\n ARR<\/jats:styled-content>\n 2.29, 95%\n CI<\/jats:styled-content>\n 1.57\u20133.36). Among deliveries with fetal distress, there were significant increases in severe perinatal morbidity\/mortality following attempted midcavity vacuum (\n ARR<\/jats:styled-content>\n 1.28, 95%\n CI<\/jats:styled-content>\n 1.04\u20131.61) and in severe maternal morbidity following attempted midcavity forceps delivery (\n ARR<\/jats:styled-content>\n 2.34, 95%\n CI<\/jats:styled-content>\n 1.54\u20133.56).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Attempted midcavity operative vaginal delivery is associated with higher rates of severe perinatal morbidity\/mortality and severe maternal morbidity, though these effects differ by indication and instrument.<\/jats:p>\n <\/jats:sec>\n \n Tweetable abstract<\/jats:title>\n Perinatal and maternal morbidity is increased following midcavity operative vaginal delivery.<\/jats:p>\n 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