{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:42:52Z","timestamp":1787985772353,"version":"build-2784847793"},"reference-count":27,"publisher":"BMJ","issue":"7456","license":[{"start":{"date-parts":[[2004,7,1]],"date-time":"2004-07-01T00:00:00Z","timestamp":1088640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2004,3,5]]},"published-print":{"date-parts":[[2004,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objective<\/jats:bold>\n                    To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design<\/jats:bold>\n                    Population based study.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Setting<\/jats:bold>\n                    US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Participants<\/jats:bold>\n                    Singleton live births in the United States (n = 11 639 388) and New Jersey (n = 375 351).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures<\/jats:bold>\n                    Neonatal morbidity and mortality.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results<\/jats:bold>\n                    Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95% confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and need for assisted ventilation (&lt; 30 minutes 0.94, 0.92 to 0.97; \u2265 30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery. The sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion<\/jats:bold>\n                    Although vacuum extraction does have risks, it remains a safe alternative to forceps delivery.\n                  <\/jats:p>","DOI":"10.1136\/bmj.329.7456.24","type":"journal-article","created":{"date-parts":[[2004,7,1]],"date-time":"2004-07-01T20:31:27Z","timestamp":1088713887000},"page":"24","source":"Crossref","is-referenced-by-count":185,"title":["Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis"],"prefix":"10.1136","volume":"329","author":[{"given":"Kitaw","family":"Demissie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George G","family":"Rhoads","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C","family":"Smulian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijal A","family":"Balasubramanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishor","family":"Gandhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K S","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2004,7,1]]},"reference":[{"key":"2025122513065347000_329.7456.24.1","unstructured":"Cunningham F MacDonald P Grant N Leveno KJ Gilstrap LI Hankins G .William's obstetrics,21 ed. New York, NY:McGraw-Hill,2001."},{"key":"2025122513065347000_329.7456.24.2","doi-asserted-by":"crossref","unstructured":"Johanson RB Menon BK .Vacuum extraction versus forceps for assisted vaginal delivery. Cochrane Database Syst Rev 2000;(2): CD000224.","DOI":"10.1002\/14651858.CD000446"},{"key":"2025122513065347000_329.7456.24.3","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536X.2002.00182.x"},{"key":"2025122513065347000_329.7456.24.4","unstructured":"US Food and Drug Administration .Public Health Advisory: need for caution when using vacuum assisted delivery devices. Rockville, MD:FDA Center for Devices and Radiological Health,1998."},{"key":"2025122513065347000_329.7456.24.5","unstructured":"National Center for Health Statistics .1995-1999 Linked birth\/infant death dataset. Hyattsville, MD:US Department of Health and Human Services, Centers for Disease Control and Prevention. (NCHS CD-Rom Series 20, Nos 12-14.)"},{"key":"2025122513065347000_329.7456.24.6","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.158.4.9802053"},{"key":"2025122513065347000_329.7456.24.7","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/oxfordjournals.aje.a116834","article-title":"Variations in the accuracy of obstetric procedures and diagnoses on birth records in Washington State, 1989.","volume":"138","author":"Parrish","year":"1993","journal-title":"Am J Epidemiol"},{"key":"2025122513065347000_329.7456.24.8","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1093\/oxfordjournals.aje.a116736","article-title":"Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records.","volume":"137","author":"Piper","year":"1993","journal-title":"Am J Epidemiol"},{"key":"2025122513065347000_329.7456.24.9","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1093\/oxfordjournals.aje.a009490","article-title":"Are we underestimating rates of vaginal birth after previous cesarean birth? The validity of delivery methods from birth certificates.","volume":"147","author":"Green","year":"1998","journal-title":"Am J Epidemiol"},{"key":"2025122513065347000_329.7456.24.10","unstructured":"Royal College of Obstetricians and Gynaecologists .Instrumental vaginal delivery. London:RCOG,2000. (Clinical Green Top Guideline No 26.)"},{"key":"2025122513065347000_329.7456.24.11","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/oxfordjournals.aje.a121625","article-title":"Sample size requirements in cohort and case-control studies of disease.","volume":"99","author":"Schlesselman","year":"1974","journal-title":"Am J Epidemiol"},{"key":"2025122513065347000_329.7456.24.12","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.2.103"},{"key":"2025122513065347000_329.7456.24.13","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1111\/j.1471-0528.1983.tb06455.x","article-title":"Portsmouth operative delivery trial: a comparison between vacuum extraction and forceps delivery.","volume":"90","author":"Vacca","year":"1983","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412301"},{"key":"2025122513065347000_329.7456.24.15","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1111\/j.1471-0528.1986.tb08633.x","article-title":"Fetal and maternal effects of forceps and vacuum extraction.","volume":"93","author":"Punnonen","year":"1986","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.16","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/j.1471-0528.1989.tb03252.x","article-title":"North Staffordshire\/Wigan assisted delivery trial.","volume":"96","author":"Johanson","year":"1989","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.17","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1111\/j.1471-0528.1988.tb12801.x","article-title":"Kielland's forceps or ventouse\u2014a comparison.","volume":"95","author":"Herabutya","year":"1988","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(96)70135-7"},{"key":"2025122513065347000_329.7456.24.19","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/j.1755-3768.1974.tb00355.x","article-title":"Retinal haemorrhages in the newborn. Comparison of delivery by forceps and by vacuum extractor.","volume":"52","author":"Ehlers","year":"1974","journal-title":"Acta Ophthalmol (Copenh)"},{"key":"2025122513065347000_329.7456.24.20","first-page":"338","article-title":"Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.","volume":"69","author":"Broekhuizen","year":"1987","journal-title":"Obstet Gynecol"},{"key":"2025122513065347000_329.7456.24.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(96)70049-2"},{"key":"2025122513065347000_329.7456.24.22","first-page":"571","article-title":"Comparison of maternal and fetal effects of vacuum extraction with forceps or cesarean deliveries.","volume":"57","author":"Greis","year":"1981","journal-title":"Obstet Gynecol"},{"key":"2025122513065347000_329.7456.24.23","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/j.1471-0528.1993.tb15301.x","article-title":"A randomised prospective study comparing the new vacuum extractor policy with forceps delivery.","volume":"100","author":"Johanson","year":"1993","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.24","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1046\/j.1471-0528.2003.01463.x","article-title":"Cohort study of operative delivery in the second stage of labour and standard of obstetric care.","volume":"110","author":"Murphy","year":"2003","journal-title":"Br J Obstet Gynaecol"},{"key":"2025122513065347000_329.7456.24.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06341-3"},{"key":"2025122513065347000_329.7456.24.26","unstructured":"US Department of Health and Human Services .Understanding and improving health and objectives for improving health. Healthy people 2010. 2nd ed. Washington, DC:US Government Printing Office,2000."},{"key":"2025122513065347000_329.7456.24.27","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.37942.546076.44"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.329.7456.24","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.329.7456.24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T21:06:59Z","timestamp":1766696819000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.329.7456.24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,7,1]]},"references-count":27,"journal-issue":{"issue":"7456","published-online":{"date-parts":[[2004,7,1]]},"published-print":{"date-parts":[[2004,7,3]]}},"alternative-id":["10.1136\/bmj.329.7456.24"],"URL":"https:\/\/doi.org\/10.1136\/bmj.329.7456.24","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,7,1]]}}}