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Vacuum extraction in twin deliveries—maternal and neonatal consequences: a retrospective cohort study

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

Abstract

Purpose

To establish the frequency of vacuum extraction among parturients with twin pregnancies, identify the risk factors and perinatal outcomes.

Methods

A retrospective cohort database study was conducted between 2005–2018. Twin fetuses with vertex presentation >34 weeks gestation who achieved vaginal delivery were included. Outcomes were compared between neonates who were delivered by vacuum extraction and neonates delivered by spontaneous vaginal delivery (aORs; [95% CI]).

Results

A total of 1751 neonates of 905 parturients with twin pregnancies met inclusion criteria, of which 163 (18%) parturients had vacuum extraction and 225 (12.8%) neonates were delivered by vacuum extraction. The most significant risk factors for vacuum extraction were primiparity (6.79 [4.77–9.66]), previous cesarean delivery (5.59 [3.13–9.97]), and epidural analgesia (4.34 [1.83–10.31]). Vacuum extractions were associated with a spectrum of adverse maternal outcomes (2.60 [1.61–4.19]), particularly postpartum hemorrhage and its associated morbidities. From the neonatal aspect, vacuum extraction deliveries were associated with a composite of birth trauma injuries (21.81 [6.43–73.91]).

Conclusion

Vacuum extractions among twin pregnancies were found to be associated with significantly higher rates of postpartum hemorrhage, blood transfusion, and perinatal birth trauma. These findings should be presented to women when counseling on mode of delivery and considered individually against cesarean delivery disadvantages.

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Funding

This study was not funded by any organization.

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Authors and Affiliations

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

    Misgav Rottenstreich, Reut Rotem, Zvi Ehrlich, Amihai Rottenstreich, Sorina Grisaru-Granovsky & Ori Shen

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

    Misgav Rottenstreich

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  1. Misgav Rottenstreich
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  2. Reut Rotem
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Contributions

MR: conception, planning, carrying out, analyzing, and writing up the work. RR: conception, planning, carrying out, analyzing, and writing up the work. ZE: planning, carrying out, analyzing, and writing up the work. AR: critical revision of the manuscript. SG: critical revision of the manuscript. OS: conception, planning, carrying out, analyzing, and writing up the work.

Corresponding author

Correspondence to Reut Rotem.

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Conflict of interest

The authors declare that they have nothing to disclose and that they have no financial or non-financial 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. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors. The Shaare Zedek Medical Center institutional review board approved the study (0083-19), with waiver of informed consent due to the retrospective, observational design of the study.

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Rottenstreich, M., Rotem, R., Ehrlich, Z. et al. Vacuum extraction in twin deliveries—maternal and neonatal consequences: a retrospective cohort study. Arch Gynecol Obstet 302, 845–852 (2020). https://doi.org/10.1007/s00404-020-05668-2

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  • DOI: https://doi.org/10.1007/s00404-020-05668-2

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