Cochrane · systematic review · CD005455
Instruments for assisted vaginal birth
Verma, GL, Spalding, JJ, Wilkinson, MD, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
21
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 7 · 25%Very low 3 · 10.7%Low 15 · 53.6%Moderate 3 · 10.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Any type of forceps compared to any type of vacuum cup for assisted vaginal delivery
Population: Women in the second stage of labour, requiring an assisted vaginal birth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed delivery with allocated instrument (primary) Any type of forceps vs any type of vacuum cup | RR 0.58 [0.39, 0.88] | 11 studies · 3080 participants | Low Downgraded: inconsistency, publication bias |
Any maternal trauma (primary) Any type of forceps vs any type of vacuum cup | OR 1.53 [0.98, 2.4] | 5 studies · 1356 participants | Low Downgraded: imprecision |
Any neonatal injury (primary) Any type of forceps vs any type of vacuum cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Third‐ or fourth‐degree perineal tear (with or without episiotomy) Any type of forceps vs any type of vacuum cup | RR 1.83 [1.32, 2.55] | 9 studies · 2493 participants | Low Downgraded: imprecision, inconsistency |
Postpartum haemorrhage (≥ 500 mL) Any type of forceps vs any type of vacuum cup | RR 1.71 [0.59, 4.95] | 2 studies · 523 participants | Low Downgraded: imprecision |
Low Apgar score at 5 minutes (< 7 or as defined by trial authors) Any type of forceps vs any type of vacuum cup | RR 0.83 [0.46, 1.51] | 7 studies · 1644 participants | Moderate Downgraded: imprecision |
Low umbilical artery pH (< 7.2 or as defined by trial authors) Any type of forceps vs any type of vacuum cup | RR 1.33 [0.91, 1.93] | 2 studies · 789 participants | Low Downgraded: imprecision |
Low‐cavity forceps compared to any vacuum cup for assisted vaginal delivery
Population: Women in the second stage of labour, requiring an assisted vaginal birth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed delivery with allocated instrument (primary) Low‐cavity forceps vs any vacuum cup | RR 0.26 [0.09, 0.76] | 2 studies · 218 participants | Very low Downgraded: risk of bias, imprecision |
Any maternal trauma (primary) Low‐cavity forceps vs any vacuum cup | OR 7.44 [0.37, 147.92] | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Any neonatal injury (primary) Low‐cavity forceps vs any vacuum cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Third‐ or fourth‐degree perineal tear (with or without episiotomy) Low‐cavity forceps vs any vacuum cup | RR 1.05 [0.55, 2] | 2 studies · 218 participants | Very low Downgraded: risk of bias, imprecision |
Postpartum haemorrhage Low‐cavity forceps vs any vacuum cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Low Apgar score at 5 minutes (< 7 or as defined by trial authors) Low‐cavity forceps vs any vacuum cup | no estimate extracted | 1 study · 118 participants | Ungraded |
Low umbilical artery pH (< 7.20 or as defined by trial authors) Low‐cavity forceps vs any vacuum cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Soft cup compared to rigid cup for assisted vaginal delivery
Population: Women in the second stage of labour, requiring an assisted vaginal birth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed delivery with allocated instrument (primary) Soft cup vs rigid cup | RR 1.62 [1.21, 2.17] | 9 studies · 1148 participants | Low Downgraded: risk of bias, imprecision |
Any maternal trauma (primary) Soft cup vs rigid cup | OR 0.63 [0.24, 1.67] | 2 studies · 348 participants | Low Downgraded: imprecision |
Any neonatal injury (primary) Soft cup vs rigid cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Third‐ or fourth‐degree perineal tear (with or without episiotomy) Soft cup vs rigid cup | RR 0.93 [0.35, 2.44] | 4 studies · 619 participants | Low Downgraded: imprecision |
Postpartum haemorrhage (≥ 500 mL or as defined by trial authors) Soft cup vs rigid cup | RR 0.89 [0.49, 1.61] | 5 studies · 737 participants | Moderate Downgraded: imprecision |
Low Apgar score at 5 minutes (less than 7 or as defined by trial authors) Soft cup vs rigid cup | RR 0.82 [0.49, 1.37] | 9 studies · 1148 participants | Low Downgraded: risk of bias, imprecision |
Low umbilical artery pH (< 7.2 or as defined by trial authors) Soft cup vs rigid cup | RR 0.8 [0.47, 1.36] | 1 study · 100 participants | Low Downgraded: imprecision |
Handheld vacuum compared to any vacuum cup for assisted vaginal delivery
Population: Women in the second stage of labour, requiring an assisted vaginal birth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failed delivery with allocated instrument (primary) Handheld vacuum vs any vacuum cup | RR 1.35 [0.81, 2.25] | 4 studies · 962 participants | Low Downgraded: imprecision, inconsistency |
Any maternal trauma (primary) Handheld vacuum vs any vacuum cup | OR 1.16 [0.71, 1.88] | 2 studies · 394 participants | Low Downgraded: imprecision |
Any neonatal injury (primary) Handheld vacuum vs any vacuum cup | no estimate extracted | 0 studies · 0 participants | Ungraded |
Third‐ or fourth‐degree perineal tear (with or without episiotomy) Handheld vacuum vs any vacuum cup | RR 1.15 [0.62, 2.12] | 4 studies · 962 participants | Moderate Downgraded: imprecision |
Postpartum haemorrhage (≥ 500 mL) Handheld vacuum vs any vacuum cup | RR 0.31 [0.03, 2.92] | 1 study · 164 participants | Low Downgraded: imprecision |
Low Apgar score at 5 minutes (< 7 or as defined by trial authors) Handheld vacuum vs any vacuum cup | RR 1.25 [0.34, 4.61] | 3 studies · 784 participants | Low Downgraded: imprecision |
Low umbilical artery pH (< 7.2 or as defined by trial authors) Handheld vacuum vs any vacuum cup | RR 1.06 [0.71, 1.59] | 1 study · 164 participants | Low Downgraded: imprecision |