Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1904-6025
Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?
Lassen sich unerwünschte fetal-maternale Outcomes bei Vakuumextraktionen vorhersagen?![](https://www.thieme-connect.de/media/gebfra/202211/lookinside/thumbnails/10-1055-a-1904-6025_gf_gebfra-2022-01-1743-or2-1.jpg)
Abstract
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).
Zusammenfassung
Einleitung Die Vakuumextraktion (VE), umgangssprachlich Saugglockenentbindung genannt, ist ein wichtiges Verfahren der modernen Geburtsheilkunde. Ihr Einsatz hat aber manchmal unerwünschte Folgen für Mutter und Kind, die mit lebenslangen Behinderungen einhergehen können. Ziel dieser Studie war es, die potenziellen Risikofaktoren für unerwünschte Outcomes zu beschreiben, die, retrospektiv gesehen, den Arzt/die Ärztin von einer VE-Entbindung abgehalten hätten.
Material und Methoden Untersucht wurde eine retrospektive Kohort von 3331 Einlingsschwangerschaften, die in der ≥ 34. SSW mithilfe der VE entbunden wurden. Bei 263 dieser Entbindungen (7,9%) kam es zu einem VE-bedingten unerwünschten Outcome für Mutter oder Kind, das als Auftreten von einem oder mehreren der nachfolgend aufgelisteten Ereignisse definiert wird: Dammriss 3.–4. Grades, subgaleatisches Hämatom, intrakraniale Blutung, Schulterdystokie, Schlüsselbeinbruch, kindliche Plexusparese oder Oberarmfraktur. Bei 3068 Entbindungen (92,1%) kam es zu keinen VE-bedingten unerwünschten Outcomes. Die 2 Gruppen wurden miteinander verglichen, um potenzielle Risikofaktoren für VE-bedingte unerwünschte Folgen auszumachen.
Ergebnisse Die multivariable Regressionsanalyse fand 7 unabhängige Risikofaktoren für VE-bedingte unerwünschte fetale oder maternale Outcomes: Nulliparität – mit einer Odds Ratio (OR) von 1,82 (95%-KI 1,11–2,98, p = 0,018), Epiduralanästhesie (OR 1,99, 95%-KI 1,42–2,80, p < 0,001), Mityvac-Ventouse-(MV-)Saugglocke (OR 1,86, 95%-KI 1,35–2,54, p < 0,001), ausgedehnte Austreibungsphase als Indikation für eine VE (OR 1,54, 95%-KI 1,11–2,15, p = 0,010), Ablösung der Saugglocke (OR 1,66, 95%-KI = 1,18–2,34, p = 0,004), lange VE-Entbindungsdauer (OR 1,07 für jede zusätzliche Minute, 95%-KI 1,03–1,11, p < 0,001) sowie ein hohes neonatales Geburtsgewicht (OR 3,42 für jedes zusätzliche Kg, 95%-KI 2,33–5,02, p < 0,001). Schutzfaktor bei der Geburt war eine vordere Hinterhauptslage des Kindes (VoHHL) (OR 0,62, 95%-KI 0,43–0,89, p = 0,010).
Schlussfolgerungen VE-bedingte unerwünschte Outcomes waren mit klinischen Merkmalen wie Nulliparität, Epiduralanästhesie, MV-Saugglocke, ausgedehnte Austreibungsphase als Indikation für eine VE, Ablösung der Saugglocke, langer VE-Entbindungsdauer sowie hohem neonatalen Geburtsgewicht korreliert. VoHHL des Kindes war ein Schutzfaktor. Diese Informationen sollten dem medizinischen Personal als Entscheidungshilfe dienen, wenn es um die Entscheidung für eine VE- oder eine Kaiserschnittentbindung geht.
Schlüsselwörter
Vakuumentbindung - Vakuumextraktion - vakuumbedingte unerwünschte Outcomes - vakuumbedingte mütterliche Komplikationen - vakuumbedingte neonatale KomplikationenKeywords
vacuum-assisted delivery - vacuum extraction - adverse outcomes of vacuum delivery - maternal complications of vacuum delivery - neonatal complications of vacuum deliveryPublication History
Received: 29 January 2022
Accepted after revision: 16 July 2022
Article published online:
07 September 2022
© 2022. 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/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Israeli Society of Maternal-Fetal Medicine. Annual report of Israeli obstetrics – Israeli Society of Maternal-Fetal medicine. 2020 Accessed December 01, 2021 at: https://cdn.mednet.co.il/2021/12/מצגת-נתונים-2020-סופית_30.11.21.pdf
- 2 Murphy DJ, Strachan BK, Bahl R. Royal College of Obstetricians and Gynaecologists. Assisted Vaginal Birth: Green-top Guideline No. 26. BJOG 2020; 127: e70-e112 DOI: 10.1111/1471-0528.16092. (PMID: 32346983)
- 3 Operative Vaginal Birth: ACOG Practice Bulletin, Number 219. Obstet Gynecol [Anonym]. 2020; 135: e149-e159 Accessed August 15, 2022 at: https://journals.lww.com/greenjournal/Abstract/2020/04000/Operative_Vaginal_Birth__ACOG_Practice_Bulletin,.57.aspx
- 4 Clark SL, Belfort MA, Dildy GA. et al. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol 2008; 199: 36.e1-36.e5 DOI: 10.1016/j.ajog.2008.03.007. (PMID: 18455140)
- 5 Zipori Y, Grunwald O, Ginsberg Y. et al. The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes. Am J Obstet Gynecol 2019; 220: 191.e1-191.e7 DOI: 10.1016/j.ajog.2018.10.028. (PMID: 30616966)
- 6 Andrews V, Sultan AH, Thakar R. et al. Risk factors for obstetric anal sphincter injury: a prospective study. Birth 2006; 33: 117-122 DOI: 10.1111/j.0730-7659.2006.00088.x. (PMID: 16732776)
- 7 Muraca GM, Sabr Y, Lisonkova S. et al. Morbidity and Mortality Associated With Forceps and Vacuum Delivery at Outlet, Low, and Midpelvic Station. J Obstet Gynaecol Can 2019; 41: 327-337 DOI: 10.1016/j.jogc.2018.06.018. (PMID: 30366887)
- 8 Fitzpatrick M, Cassidy M, O’Connell PR. et al. Experience with an obstetric perineal clinic. Eur J Obstet Gynecol Reprod Biol 2002; 100: 199-203 DOI: 10.1016/s0301-2115(01)00427-4. (PMID: 11750965)
- 9 Pretlove S, Thompson PJ, Toozs-Hobson PM. et al. The first 18 months of a new perineal trauma clinic. J Obstet Gynaecol 2004; 24: 399-402 DOI: 10.1080/01443610410001685538. (PMID: 15203580)
- 10 Sheiner E, Sarid L, Levy A. et al. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: A population-based study. J Matern Fetal Neonatal Med 2005; 18: 149-154 DOI: 10.1080/14767050500170088. (PMID: 16272036)
- 11 Ahn ES, Jung MS, Lee YK. et al. Neonatal clavicular fracture: recent 10 year study. Pediatr Int 2015; 57: 60-63 DOI: 10.1111/ped.12497. (PMID: 25203556)
- 12 Mollberg M, Hagberg H, Bager B. et al. Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction. Obstet Gynecol 2005; 106: 913-918 DOI: 10.1097/01.AOG.0000183595.32077.83. (PMID: 16260506)
- 13 Hughes CA, Harley EH, Milmoe G. et al. Birth trauma in the head and neck. Arch Otolaryngol Head Neck Surg 1999; 125: 193-199 DOI: 10.1001/archotol.125.2.193. (PMID: 10037286)
- 14 Ekéus C, Wrangsell K, Penttinen S. et al. Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction). J Matern Fetal Neonatal Med 2018; 31: 2402-2408 DOI: 10.1080/14767058.2017.1344631. (PMID: 28629251)
- 15 Uchil D, Arulkumaran S. Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction. Obstet Gynecol Surv 2003; 58: 687-693 DOI: 10.1097/01.OGX.0000086420.13848.89. (PMID: 14515066)
- 16 Dall’Asta A, Ghi T, Pedrazzi G. Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature. Eur J Obstet Gynecol Reprod Biol 2016; 204: 62-68 DOI: 10.1016/j.ejogrb.2016.07.506. (PMID: 27522245)
- 17 Operative Vaginal Birth: ACOG Practice Bulletin, Number 219. Obstet Gynecol [Anonym]. 2020; 135: e149-e159 DOI: 10.1097/AOG.0000000000003764.
- 18 ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol [Anonym]. 2018; 131: e49-e64 DOI: 10.1097/AOG.0000000000002501.
- 19 American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol 2016; 128: e1-e15 DOI: 10.1097/AOG.0000000000001523. (PMID: 27333357)
- 20 Macones GA, Hankins GD, Spong CY. et al. The 2008 national institute of child health and human development workshop report on electronic fetal monitoring: Update on definitions, interpretation, and research guidelines. J Obstet Gynecol Neonatal Nurs 2008; 37: 510-515 DOI: 10.1111/j.1552-6909.2008.00284.x. (PMID: 18761565)
- 21 Caughey AB, Cahill AG, Guise JM. American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine. et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210: 179-193 DOI: 10.1016/j.ajog.2014.01.026. (PMID: 24565430)
- 22 Plauché WC. Subgaleal hematoma. A complication of instrumental delivery. JAMA 1980; 244: 1597-1598 (PMID: 7420661)
- 23 Swanson AE, Veldman A, Wallace EM. et al. Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand 2012; 91: 260-263 DOI: 10.1111/j.1600-0412.2011.01300.x. (PMID: 21995823)
- 24 Levin G, Rottenstreich A, Tsur A. et al. Risk factors for obstetric anal sphincter injury among parous women. Arch Gynecol Obstet 2021; 303: 709-714 DOI: 10.1007/s00404-020-05806-w. (PMID: 32975606)
- 25 Gherman RB, Chauhan S, Ouzounian JG. et al. Shoulder dystocia: the unpreventable obstetric emergency with empiric management guidelines. Am J Obstet Gynecol 2006; 195: 657-672 DOI: 10.1016/j.ajog.2005.09.007. (PMID: 16949396)
- 26 Ouzounian JG, Korst LM, Miller DA. et al. Brachial plexus palsy and shoulder dystocia: obstetric risk factors remain elusive. Am J Perinatol 2013; 30: 303-307 DOI: 10.1055/s-0032-1324698. (PMID: 22898994)
- 27 Segal D, Baumfeld Y, Yahav L. et al. Risk factors for obstetric anal sphincter injuries (OASIS) during vacuum extraction delivery in a university affiliated maternity hospital. J Matern Fetal Neonatal Med 2020; 33: 999-1003 DOI: 10.1080/14767058.2018.1514376. (PMID: 30231781)
- 28 Weissbach T, Hag-Yahia N, Ovadia M. et al. Kiwi OmniCup Handheld vs. Mityvac M-Style Conventional Vacuum System: A Retrospective Observational Study. J Matern Fetal Neonatal Med 2018; 31: 3178-3182 DOI: 10.1080/14767058.2017.1366443. (PMID: 28793827)
- 29 Krispin E, Aviram A, Salman L. et al. Cup detachment during vacuum-assisted vaginal delivery and birth outcome. Arch Gynecol Obstet 2017; 296: 877-883 DOI: 10.1007/s00404-017-4507-5. (PMID: 28871450)
- 30 Levin G, Elchalal U, Yagel S. et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98: 1464-1472 DOI: 10.1111/aogs.13678. (PMID: 31220332)
- 31 Robertson PA, Laros jr. RK, Zhao RL. et al. Neonatal and maternal outcome in low-pelvic and midpelvic operative deliveries. Am J Obstet Gynecol 1990; 162: 1436-1442 DOI: 10.1016/0002-9378(90)90903-k. (PMID: 2360576)
- 32 Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med 2018; 15: e1002494 DOI: 10.1371/journal.pmed.1002494. (PMID: 29360829)
- 33 van Dillen J, Zwart JJ, Schutte J. et al. Severe acute maternal morbidity and mode of delivery in the Netherlands. Acta Obstet Gynecol Scand 2010; 89: 1460-1465 DOI: 10.3109/00016349.2010.519018. (PMID: 20955100)
- 34 Liu S, Liston RM, Joseph KS. et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176: 455-460 DOI: 10.1503/cmaj.060870. (PMID: 17296957)
- 35 Marschalek ML, Worda C, Kuessel L. et al. Risk and protective factors for obstetric anal sphincter injuries: A retrospective nationwide study. Birth 2018; 45: 409-415 DOI: 10.1111/birt.12346. (PMID: 29537100)
- 36 American Academy of Pediatric. Statement of Endorsement. Neonatal Encephalopathy and Neurologic Outcome, Second Edition. Pediatrics 2014; 133: e1482-e1488 DOI: 10.1542/peds.2014-0724.
- 37 Shmueli A, Salman L, Ashwal E. et al. Perinatal outcomes of vacuum assisted versus cesarean deliveries for prolonged second stage of delivery at term. J Matern Fetal Neonatal Med 2017; 30: 886-889 DOI: 10.1080/14767058.2016.1191066. (PMID: 27188481)
- 38 Muraca GM, Skoll A, Lisonkova S. et al. Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery. BJOG 2018; 125: 693-702 DOI: 10.1111/1471-0528.14820. (PMID: 28692173)
- 39 Salman L, Aviram A, Krispin E. et al. Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?. Arch Gynecol Obstet 2017; 295: 1145-1150 DOI: 10.1007/s00404-017-4339-3. (PMID: 28324223)
- 40 Sainz JA, García-Mejido JA, Aquise A. et al. A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps. Am J Obstet Gynecol 2019; 220: 193.e1-193.e12 DOI: 10.1016/j.ajog.2018.10.035. (PMID: 30391443)
- 41 Romero S, Pettersson K, Yousaf K. et al. Perinatal outcome after vacuum assisted delivery with digital feedback on traction force; a randomised controlled study. BMC Pregnancy Childbirth 2021; 21: 165 DOI: 10.1186/s12884-021-03604-z. (PMID: 33637058)
- 42 Halscott TL, Reddy UM, Landy HJ. et al. Maternal and Neonatal Outcomes by Attempted Mode of Operative Delivery From a Low Station in the Second Stage of Labor. Obstet Gynecol 2015; 126: 1265-1272 DOI: 10.1097/AOG.0000000000001156. (PMID: 26551186)
- 43 Ahlberg M, Norman M, Hjelmstedt A. et al. Risk factors for failed vacuum extraction and associated complications in term newborn infants: a population-based cohort study. J Matern Fetal Neonatal Med 2016; 29: 1646-1651 DOI: 10.3109/14767058.2015.1057812. (PMID: 26135756)
- 44 Miot S, Riethmuller D, Deleplancque K. et al. Cesarean section for failed vacuum extraction: risk factors and maternal and neonatal outcomes. Gynecol Obstet Fertil 2004; 32: 607-612 DOI: 10.1016/j.gyobfe.2004.04.003. (PMID: 15450259)
- 45 Sheiner E, Shoham-Vardi I, Silberstein T. et al. Failed vacuum extraction. Maternal risk factors and pregnancy outcome. J Reprod Med 2001; 46: 819-824 (PMID: 11584484)