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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2022
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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). |
format | Online Article Text |
id | pubmed-9633228 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
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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