Strengths and Limitations
The main strengths of this study were the high number of women included,
the completeness of the data collection and the very small amount of
missing data. This resulted in a solid database that allowed us to
obtain significant results from various analyses, including the
multivariate analysis.
One limitation of our study is the monocentric design. In our obstetrics
department, 80 % of OVDs are conducted with vacuum assistance, and
mid-cavity OVDs account for 35 % of all operative deliveries. The
overall rate of C-section is approximately 15 %. These characteristics
allowed us to obtain a large study population, but they may affect the
external validity of our study. Thus, the implementation of our score is
possible in teams who regularly practice VAD. The use of this score
implies the presence of an experienced obstetrician from the outset for
all attempts at mid-cavity VAD.