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Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?

Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physici...

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Autores principales: Cohen, Gal, Schreiber, Hanoch, Shalev Ram, Hila, Ovadia, Michal, Shechter-Maor, Gil, Biron-Shental, Tal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633228/
https://www.ncbi.nlm.nih.gov/pubmed/36339635
http://dx.doi.org/10.1055/a-1904-6025
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author Cohen, Gal
Schreiber, Hanoch
Shalev Ram, Hila
Ovadia, Michal
Shechter-Maor, Gil
Biron-Shental, Tal
author_facet Cohen, Gal
Schreiber, Hanoch
Shalev Ram, Hila
Ovadia, Michal
Shechter-Maor, Gil
Biron-Shental, Tal
author_sort Cohen, Gal
collection PubMed
description Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3–4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb’s palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes. Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity – with an odds ratio (OR) of 1.82 (95% CI = 1.11–2.98, p = 0.018), epidural anesthesia (OR 1.99, CI = 1.42–2.80, p < 0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI = 1.35–2.54, p < 0.001), prolonged second stage as indication for VE (OR 1.54, CI = 1.11–2.15, p = 0.010), cup detachment (OR 1.66, CI = 1.18–2.34, p = 0.004), increasing procedure duration (OR 1.07 for every additional minute, CI = 1.03–1.11, p < 0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI = 2.33–5.02, p < 0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI = 0.43–0.89, p = 0.010). Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD).
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spelling pubmed-96332282022-11-04 Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction? Cohen, Gal Schreiber, Hanoch Shalev Ram, Hila Ovadia, Michal Shechter-Maor, Gil Biron-Shental, Tal Geburtshilfe Frauenheilkd Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3–4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb’s palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes. Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity – with an odds ratio (OR) of 1.82 (95% CI = 1.11–2.98, p = 0.018), epidural anesthesia (OR 1.99, CI = 1.42–2.80, p < 0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI = 1.35–2.54, p < 0.001), prolonged second stage as indication for VE (OR 1.54, CI = 1.11–2.15, p = 0.010), cup detachment (OR 1.66, CI = 1.18–2.34, p = 0.004), increasing procedure duration (OR 1.07 for every additional minute, CI = 1.03–1.11, p < 0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI = 2.33–5.02, p < 0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI = 0.43–0.89, p = 0.010). Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD). Georg Thieme Verlag KG 2022-09-07 /pmc/articles/PMC9633228/ /pubmed/36339635 http://dx.doi.org/10.1055/a-1904-6025 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Cohen, Gal
Schreiber, Hanoch
Shalev Ram, Hila
Ovadia, Michal
Shechter-Maor, Gil
Biron-Shental, Tal
Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title_full Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title_fullStr Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title_full_unstemmed Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title_short Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
title_sort can we predict feto-maternal adverse outcomes of vacuum extraction?
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9633228/
https://www.ncbi.nlm.nih.gov/pubmed/36339635
http://dx.doi.org/10.1055/a-1904-6025
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