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Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?

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

Abstract

Purpose

To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome.

Methods

Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007–2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders.

Result

Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04–1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26–4.67) and asphyxia (aOR 1.81 95% CI 1.35–2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38–2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity.

Conclusion

The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5′ Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.

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Author contributions

LS: contributed to all process of submission from the preliminary hypothesis, data collection, data analysis, and manuscript writing. AA: data collection and analysis. EK: data collection and analysis. RC: project development and manuscript writing. AW: project development and manuscript writing. RG-B: contributed to all process of submission from the preliminary hypothesis, data collection, data analysis, and manuscript writing.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel

    Lina Salman, Amir Aviram, Eyal Krispin, Arnon Wiznitzer, Rony Chen & Rinat Gabbay-Benziv

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

    Lina Salman, Amir Aviram, Eyal Krispin, Arnon Wiznitzer, Rony Chen & Rinat Gabbay-Benziv

Authors
  1. Lina Salman
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  2. Amir Aviram
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  4. Arnon Wiznitzer
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  5. Rony Chen
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  6. Rinat Gabbay-Benziv
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Correspondence to Rinat Gabbay-Benziv.

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The authors report no conflicts of interest.

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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.

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Salman, L., Aviram, A., Krispin, E. et al. Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?. Arch Gynecol Obstet 295, 1145–1150 (2017). https://doi.org/10.1007/s00404-017-4339-3

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  • DOI: https://doi.org/10.1007/s00404-017-4339-3

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