Neonatal morbidity in a low volume forceps practice

Background: Currently, the use of FE is decreasing and neonatal adverse outcomes following FE are underreported. We aimed to evaluate the rate of neonatal adverse outcomes in current obstetric practice at two university hospitals with a low FE volume. Methods: A multicentre retrospective study. All singleton pregnancies delivered by forceps extraction between 2011 and 2020 were analyzed. The characteristics of the deliveries with a composite neonatal adverse outcome (CNAO) were analyzed and compared with those without. Results: The study cohort included 861 neonates delivered by FE. The CNAO was recorded in 131 (15.2%). Women in the CNAO group gained less weight during pregnancy (mean 13 kg vs. 15 kg, p =.014). Factors found to be associated with CNAO were preterm delivery (gestational age < 37°^/7) (26 (19.8%) vs. 44 (6.0%), OR [95% CI]: 3.86 (2.28–6.52), p <.001), low birth weight (23 (17.6%) vs. 44 (6.0%), OR [95% CI] 3.32 (1.92–5.71), p <.001), and smaller head circumference (329 vs. 331 mm, OR [95% CI] 0.79 (0.67–0.93), p =.035). In a multivariate analysis, gestational age (adjusted OR [95% CI] 0.672 (0.546–0.826), p <.001) and maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.950 (0.904–0.998), p =.042), were both negatively associated with CNAO. Among term deliveries, the only factor found to be independently associated with CNAO was maternal weight gain during pregnancy (adjusted OR [95% CI]: 0.951 (0.910–0.994), p =.025). Conclusions: In the setting of low volume FE, this mode of delivery is associated with a relatively low rate of neonatal morbidity. Synopsis: Performance of forceps extraction in the setting of low volume practice is associated with a relatively low rate of neonatal morbidity.