• Giulia M Muraca, Amélie Boutin, Neda Razaz, Sarka Lisonkova, Sid John, Joseph Y Ting, Heather Scott, Michael S Kramer, and K S Joseph.
• Department of Obstetrics and Gynaecology (Muraca, Boutin, Lisonkova, John, Joseph), University of British Columbia, Vancouver, BC; Clinical Epidemiology Unit, Department of Medicine (Muraca, Razaz), Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics (Boutin), Université Laval, Québec City, Quebec; School of Population and Public Health (Lisonkova, Joseph); Division of Neonatology, Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology (Scott), Dalhousie University and the IWK Health Centre, Halifax, NS; Departments of Epidemiology and Occupation Health and of Pediatrics (Kramer), McGill University, Montréal, Que. giulia.muraca@ki.se.
• CMAJ. 2022 Jan 10; 194 (1): E1E12E1-E12.

BackgroundOperative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.MethodsWe conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.ResultsOf 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.InterpretationIn Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.© 2022 CMA Impact Inc. or its licensors.

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