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Vacuum extraction delivery at first vaginal birth following cesarean: maternal and neonatal outcome

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

A Correspondence to this article was published on 19 April 2021

A Correspondence to this article was published on 30 March 2021

Abstract

Objective

To evaluate the maternal and neonatal morbidity outcome associated with vacuum assisted (VA) vaginal delivery at first vaginal birth following a previous cesarean delivery (CD).

Study design

This is a retrospective computerized study conducted at a single tertiary center, between 2005 and 2018. The study compared the morbidity outcome of VA vaginal delivery between two groups of parturients at their first vaginal birth; primigravid and those in second delivery with a prior cesarean. The primary outcome was the maternal adverse outcome: postpartum hemorrhage (PPH), anal sphincter injuries, retained placenta, shoulder dystocia, uterine rupture, and intensive care unit (ICU) admissions. Secondary outcome was the neonatal adverse outcome: Apgar score, NICU admission, meconium aspiration, jaundice, sepsis, birth trauma, and death. Univariate analysis was followed by a multiple logistic regression model controlling for potential confounders, adjusted odds ratios (95% confidence interval).

Results

During the study period, we identified 3695 parturients that engaged in Trial of labor after cesarean with no previous vaginal birth, among which 679 (18.4%) delivered by Vacuum (VA-VBAC). These were compared to 6544/43,083 (15.2%) primigravid delivered by Vacuum. The VA-VBAC group had higher risk of PPH (10.5% vs. 7.2%, p < 0.01), blood transfusions (5.6% vs. 3.5%, p < 0.01), retained placenta (10.2% vs. 4.7%, p < 0.01), and uterine rupture (0.4% vs. 0%, p < 0.01). The adverse neonatal outcomes were comparable among groups.

Conclusion

The VA-VBAC has a higher risk of maternal postpartum hemorrhagic complications; preventive measures should be directed to this selected group of operative vaginal deliveries.

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Funding

This study was not funded by any organization.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 12 Bayit Street, 91031, Jerusalem, Israel

    Misgav Rottenstreich, Reut Rotem, Biana Katz & Sorina Grisaru-Granovsky

  2. Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel

    Misgav Rottenstreich

  3. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Amihai Rottenstreich

Authors
  1. Misgav Rottenstreich
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  2. Reut Rotem
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  3. Biana Katz
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  4. Amihai Rottenstreich
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  5. Sorina Grisaru-Granovsky
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Contributions

MR: Protocol development, data collection and management, data analysis, manuscript writing/editing. RR: Protocol development, data collection, and management, data analysis, manuscript writing/editing. BK: Data collection and management, manuscript writing/editing. AR: Protocol development, manuscript writing/editing. SG-G: Protocol development, data collection and management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Reut Rotem.

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The authors report no conflict of interest.

Informed consent

In accordance with Ministry of Health regulations, the institutional ethics committee did not require written informed consent because the data were obtained anonymously from medical records, with no direct participation of patients.

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Misgav Rottenstreich and Reut Rotem have equally contributed.

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Rottenstreich, M., Rotem, R., Katz, B. et al. Vacuum extraction delivery at first vaginal birth following cesarean: maternal and neonatal outcome. Arch Gynecol Obstet 301, 483–489 (2020). https://doi.org/10.1007/s00404-020-05443-3

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  • DOI: https://doi.org/10.1007/s00404-020-05443-3

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