Assistant Professor


Curriculum vitae



Department of Obstetrics and Gynecology

Department of Health Research Methods, Evidence and Impact

McMaster University
1280 Main St. West,
HSC3V - 43B
Hamilton, Ontario ​L8S 4K1
Canada



Ecological association between operative vaginal delivery and obstetric and birth trauma


Journal article


Giulia M Muraca, Sarka Lisonkova, Amanda Skoll, Rollin Brant, Geoffrey W Cundiff, Yasser Sabr, KS Joseph
Canadian Medical Association Journal, vol. 190(24), 2018, pp. E734-E741


Semantic Scholar DOI PubMed
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APA   Click to copy
Muraca, G. M., Lisonkova, S., Skoll, A., Brant, R., Cundiff, G. W., Sabr, Y., & Joseph, K. S. (2018). Ecological association between operative vaginal delivery and obstetric and birth trauma. Canadian Medical Association Journal, 190(24), E734–E741. https://doi.org/10.1503/cmaj.17107


Chicago/Turabian   Click to copy
Muraca, Giulia M, Sarka Lisonkova, Amanda Skoll, Rollin Brant, Geoffrey W Cundiff, Yasser Sabr, and KS Joseph. “Ecological Association between Operative Vaginal Delivery and Obstetric and Birth Trauma.” Canadian Medical Association Journal 190, no. 24 (2018): E734–E741.


MLA   Click to copy
Muraca, Giulia M., et al. “Ecological Association between Operative Vaginal Delivery and Obstetric and Birth Trauma.” Canadian Medical Association Journal, vol. 190, no. 24, 2018, pp. E734–E741, doi:10.1503/cmaj.17107.


BibTeX   Click to copy

@article{giulia2018a,
  title = {Ecological association between operative vaginal delivery and obstetric and birth trauma},
  year = {2018},
  issue = {24},
  journal = {Canadian Medical Association Journal},
  pages = {E734-E741},
  volume = {190},
  doi = {10.1503/cmaj.17107},
  author = {Muraca, Giulia M and Lisonkova, Sarka and Skoll, Amanda and Brant, Rollin and Cundiff, Geoffrey W and Sabr, Yasser and Joseph, KS}
}

Abstract

BACKGROUND: Increased use of operative vaginal delivery (use of forceps, vacuum or other device) has been recommended to address high rates of cesarean delivery. We sought to determine the association between rates of operative vaginal delivery and obstetric trauma and severe birth trauma. METHODS: We carried out an ecological analysis of term, singleton deliveries in 4 Canadian provinces (2004–2014) using data from the Canadian Institute for Health Information. The primary exposure was mode of delivery. The primary outcomes were obstetric trauma and severe birth trauma. RESULTS: Data on 1 938 913 deliveries were analyzed. The rate of obstetric trauma was 7.2% in nulliparous women, and 2.2% and 2.7% among parous women without and with a previous cesarean delivery, respectively, and rates of severe birth trauma were 2.1, 1.7 and 0.7 per 1000, respectively. Each 1% absolute increase in rates of operative vaginal delivery was associated with a higher frequency of obstetric trauma among nulliparous women (adjusted rate ratio [ARR] 1.06, 95% confidence interval [CI] 1.05–1.06), parous women without a previous cesarean delivery (ARR 1.10, 95% CI 1.08–1.13) and parous women with a previous cesarean delivery (ARR 1.11, 95% CI 1.07–1.16). Operative vaginal delivery was associated with more frequent severe birth trauma, but only in nulliparous women (ARR 1.05, 95% CI 1.03–1.07). In nulliparous women, sequential vacuum and forceps instrumentation was associated with the largest increase in obstetric trauma (ARR 1.44, 95% CI 1.35–1.55) and birth trauma (ARR 1.53, 95% CI 1.03–2.27). INTERPRETATION: Increases in population rates of operative vaginal delivery are associated with higher population rates of obstetric trauma, and in nulliparous women with severe birth trauma.


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