The authors reported that the incidence of intracranial (subarachnoid, subdural, intraparenchymal, and/or intraventricular) hemorrhage was highest in infants delivered by both vacuum and forceps (1 in 256) as compared with infants born by forceps (1 in 664) or vacuum extraction alone (1 in 860), cesarean selleckchem Erlotinib delivery in labor (1 in 907), spontaneous vaginal delivery (1 in 1900), and elective cesarean delivery prior to labor (1 in 2705). A similar study by Gardella and colleagues60 used Washington state birth certificate data linked to hospital discharge records to compare perinatal outcome in 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, 3741 forceps deliveries, and 11,223 spontaneous vaginal deliveries.

The study found that the sequential use of vacuum and forceps was associated with significantly increased risk of both neonatal and maternal injury.60 Not all cases of intracranial hemorrhage are symptomatic. A prospective study on 111 asymptomatic term infants who underwent routine magnetic resonance imaging shortly after delivery found that infants delivered after a failed vacuum extraction were the most likely to have a subdural hemorrhage with a rate of approximately 28% versus 6% after spontaneous vaginal delivery and 8% after a successful vacuum delivery.61 Routine Use of Antibiotics at the Time of Assisted Vaginal Delivery There is insufficient evidence to support the routine administration of antibiotic prophylaxis during assisted vaginal deliveries to prevent postpartum infection.

A retrospective review of 393 women compared the rates of endomyometritis among women delivered by vacuum or forceps, and found no statistical difference in the rates of infection or the length of hospitalization among those who received prophylactic antibiotics and those who did not.62 As such, the routine use of antibiotic prophylaxis at the time of operative vaginal delivery cannot be recommended. Use of Episiotomy at the Time of Assisted Vaginal Delivery Episiotomy refers to a surgical incision in the perineum designed to enlarge the vagina and assist in childbirth. Although episiotomy has often accompanied operative vaginal delivery, recent evidence suggests that routine use of episiotomy with vacuum extraction is associated with an increased rather than decreased risk of perineal trauma and rectal injuries.

63,64 Episiotomy during operative vaginal delivery also incre
Listeriosis is a rare infection, but is about 20 times more common in pregnant women than in the general population.1 Cilengitide Pregnant women account for 27% of all listerial infections,2 which can cause mild illness in mothers, but can be devastating to the fetus, in some cases leading to severe disease or fetal death.3 Pregnant women may be able to reduce risk of listerial infection by following dietary guidelines recommended by the Centers for Disease Control and Prevention (CDC) (see Table 3).