Skip to main content
SpringerLink
Log in

Cup detachment during vacuum-assisted vaginal delivery and birth outcome

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

Abstract

Objective

To determine the perinatal outcome associated with cup detachment during vacuum-assisted vaginal delivery (VAVD).

Methods

A retrospective cohort study of all women attempting VAVD in a tertiary hospital (2012–2014). Singleton-term pregnancies were included. Antepartum fetal death and major fetal structural or chromosomal abnormalities were excluded. Primary outcome was neonatal birth trauma (subgaleal hematoma, subarachnoid hematoma, subdural hematoma, skull fracture, and/or erb’s palsy). Secondary outcomes were maternal complications or other neonatal morbidities. Outcomes were compared between women after ≥1 cup detachment (study group) and the rest (control group). Logistic regression analysis was utilized to adjust results to potential confounders.

Results

Overall, 1779 women attempted VAVD during study period. Of them, in 146 (8.2%), the cup detached prior to delivery; 130/146 (89%) had a single detachment. After detachment, 4 (2.7%) delivered by cesarean section, 77 (52.7%) delivered after cup reapplication, and 65 (44.6%) delivered spontaneously. Women in the study group were more likely to undergo VAVD due to prolonged second stage, and were characterized by lower rates of metal cup use. Neonates in the detachment group had higher rates of subarachnoid hematoma and composite neonatal birth trauma (2.7 vs. 0.1% and 4.8 vs. 1.8%, respectively, p < 0.05). This remained significant after adjustment to potential confounders (subarachnoid hematoma aOR = 45.44, 95% CI 6.42–321.62 and neonatal birth trauma aOR = 2.62, 95% CI 1.1–6.22, p < 0.05 for all). Other neonatal and maternal morbidities were similar between groups.

Conclusion

Cup detachment is associated with a higher rate of adverse neonatal outcome. Cup reapplication should be considered carefully.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

VAVD:

Vacuum-assisted vaginal delivery

NRFHR:

Non-reassuring fetal heart rate

NICU:

Neonatal intensive care unit

References

  1. Clark SL, Belfort MA, Hankins GD, Meyers JA, Houser FM (2007) Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol 196:526

    PubMed  Google Scholar 

  2. Committee on Practice (2015) Bulletins—obstetrics. ACOG practice bulletin no. 154: operative vaginal delivery. Obstet Gynecol 126:56–65

    Article  Google Scholar 

  3. O’Mahony F, Hofmeyr GJ, Menon V (2010) Choice of instruments for assisted vaginal delivery. Cochrane Database Syst Rev 11:CD005455. doi:10.1002/14651858

  4. Salman L, Aviram A, Krispin E, Wiznitzer A, Chen R, Gabbay-Benziv R (2017) Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter? Arch Gynecol Obstet 295(5):1145–1150

    Article  PubMed  Google Scholar 

  5. Harlev A, Fatool SK, Sergienko R, Sheiner E (2017) Non-progressive labor in the second stage leading to vacuum extraction is a risk factor for recurrent non-progressive labor. Arch Gynecol Obstet 295:1393–1398

    Article  PubMed  Google Scholar 

  6. Kessous R, Tirosh D, Weintraub AY, Benshalom-Tirosh N, Sergienko R, Sheiner E (2013) Second stage disorders in patients following a previous cesarean section: vacuum versus repeated cesarean section. Arch Gynecol Obstet 287:1075–1079

    Article  PubMed  Google Scholar 

  7. Simonson C, Barlow P, Dehennin N, Sphel M, Toppet V, Murillo D et al (2007) Neonatal complications of vacuum-assisted delivery. Obstet Gynecol 109:626

    Article  PubMed  Google Scholar 

  8. Sheiner E, Shoham-Vardi I, Silberstein T, Hallak M, Katz M, Mazor M (2001) Failed vacuum extraction. Maternal risk factors and pregnancy outcome. J Reprod Med 46:819–824

    CAS  PubMed  Google Scholar 

  9. Mastrolia SA, Wainstock T, Sheiner E, Landau D, Sergienko R, Walfisch A (2017) Failed vacuum and the long-term neurological impact on the offspring. Am J Perinatol. doi:10.1055/s-0037-1603507

  10. Meyer S, Schreyer A, De Grandi P, Hohlfeld P (1998) The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics. Obstet Gynecol 92:613

    CAS  PubMed  Google Scholar 

  11. Edozien LC (2007) Towards safe practice in instrumental vaginal delivery. Best Pract Res Clin Obstet Gynaecol 21:639

    Article  PubMed  Google Scholar 

  12. Gardella C, Taylor M, Benedetti T, Hitti J (2001) Critchlow C The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes. Am J Obstet Gynecol 185:896

    Article  CAS  PubMed  Google Scholar 

  13. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2012) Instrumental vaginal delivery. College statement C-Obs 16. 2012 East Melbourne, Australia: RANZCOG; 2012. https://www.ranzcog.edu.au/doc/instrumentalvaginal-delivery.html. Accessed Nov 2015

  14. Macones GA, Hankins GD, Spong CY, Hauth J, Moore T (2008) The 2008 National Institute of child health and human development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol 112:661–666

    Article  PubMed  Google Scholar 

  15. Friedman E (1972) An objective approach to the diagnosis and management of abnormal labor. Bull N Y Acad Med 48:842

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Ben-Haroush A, Melamed N, Kaplan B, Yogev Y (2007) Predictors of failed operative vaginal delivery: a single-center experience. Am J Obstet Gynecol 197:308

    PubMed  Google Scholar 

  17. Mikovsky P, Watson WJ (2001) Obstetric vacuum extraction: state of the art in the new millennium. Obstet Gynecol Surv 56(11):736–751

    Article  Google Scholar 

  18. Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR (2012) Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 120:1181–1193

    PubMed  PubMed Central  Google Scholar 

  19. Johanson R, Menon V (2000) Soft versus rigid vacuum extractor cups for assisted vaginal delivery. Cochrane Database Syst Rev. 2:CD000446

    Google Scholar 

  20. Walsh CA, Robson M, McAuliffe FM (2013) Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol 121:122–128

    Article  PubMed  Google Scholar 

  21. Murphy DJ, Macleod M, Bahl R, Strachan B (2011) A cohort study of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol 156:41–45

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel

    Eyal Krispin, Lina Salman, Rony Chen & Arnon Wiznitzer

  2. The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eyal Krispin, Amir Aviram, Lina Salman, Rony Chen & Arnon Wiznitzer

  3. Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Amir Aviram

  4. Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel

    Rinat Gabbay-Benziv

  5. The Bruce and Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Rinat Gabbay-Benziv

Authors
  1. Eyal Krispin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amir Aviram
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lina Salman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rony Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arnon Wiznitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rinat Gabbay-Benziv
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Eyal Krispin, MD protocol development, data analysis, and manuscript writing. Amir Aviram, MD data collection and analysis. Lina Salman, MD data collection and analysis. Rony Chen, MD protocol development and manuscript editing. Arnon Wiznitzer, MD: protocol development and manuscript editing. Rinat Gabbay-Benziv, MD protocol development, data analysis, and manuscript writing.

Corresponding author

Correspondence to Rinat Gabbay-Benziv.

Ethics declarations

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krispin, E., Aviram, A., Salman, L. et al. Cup detachment during vacuum-assisted vaginal delivery and birth outcome. Arch Gynecol Obstet 296, 877–883 (2017). https://doi.org/10.1007/s00404-017-4507-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4507-5

Keywords

Search

Navigation