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Autores principales:	Parnian Hossein‐Pour, Maya Rajasingham, Giulia M. Muraca
Formato:	Artículo Open Access
Publicado:	Wiley 2024
Materias:	Acta Obstetricia et Gynecologica Scandinavica
Acceso en línea:	https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.14969
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

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Risk of cervical laceration in forceps vs vacuum delivery: A systematic review and meta‐analysis Parnian Hossein‐Pour Maya Rajasingham Giulia M. Muraca Acta Obstetricia et Gynecologica Scandinavica AbstractIntroductionCervical laceration is an obstetric injury associated with severe postpartum hemorrhage and subsequent spontaneous preterm birth. While operative vaginal delivery is a known risk factor for cervical laceration, it is unclear whether forceps and vacuum deliveries incur the same risk. The aim of this systematic review was to compare the risk of cervical laceration between operative instruments (forceps vs vacuum).Material and MethodsMedline, Embase, Global Health, CENTRAL, Emcare, and Web of Science were searched from inception until August 2024 with terms related to operative vaginal delivery and cervical laceration. Studies comparing the risk of cervical laceration in individuals undergoing forceps or vacuum delivery were included. Two authors conducted screening, data extraction, and quality assessment of all studies. Random‐effects models were used to pool risk ratios across studies and certainty of evidence was assessed using Cochrane methods and the GRADE approach. PROSPERO Registration Number CRD42023421890.ResultsThirteen studies were eligible for inclusion, 3 randomized controlled trials (RCTs) and 10 observational studies. The overall rate of cervical laceration was 0.35% (990/284218 births) where 1.04% of forceps deliveries (456/43817) were complicated by cervical laceration compared to 0.22% of vacuum deliveries (534/240401). The risk of cervical laceration was 2–5 fold greater in forceps deliveries than in vacuum deliveries: pooled unadjusted risk ratio [RR] 4.83, 95% confidence interval [CI] 1.56–14.98 among RCTs and pooled unadjusted RR 1.89, 95% CI 1.59–2.24 among observational studies. The overall quality of evidence was low to moderate mainly due to the lack of attention to confounding in the included literature. The GRADE assessment indicated that the certainty of evidence was very low for observational studies and moderate for RCTs.ConclusionsLow certainty of evidence indicates that forceps deliveries may be associated with an increased risk of cervical laceration compared to vacuum deliveries. 10.1111/aogs.14969 http://creativecommons.org/licenses/by-nc-nd/4.0/

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// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

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