Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications

Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal an...

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Published in:PloS one 2021-11, Vol.16 (11), p.e0259926-e0259926
Main Authors: Sugulle, Meryam, Halldórsdóttir, Erna, Kvile, Janne, Berntzen, Line Sissel Dahlgaard, Jacobsen, Anne Flem
Format: Article
Language:English
Subjects:
Adult
Biology and Life Sciences
Birth weight
Cesarean section
Cesarean Section - statistics & numerical data
Chi square analysis
Chi-square test
Childbirth & labor
Clinical medicine
Complications
Confidence intervals
Failure rates
Female
Gestational age
Gynecology
Health risks
High vacuum
Hospitals, University
Humans
Injuries
Labor
Labor Onset
Maternal Age
Medical instruments
Medicine
Medicine and Health Sciences
Methods
Morbidity
Neonates
Newborn babies
Obstetric Labor Complications - epidemiology
Obstetric Labor Complications - etiology
Obstetrical Forceps
Obstetrics
Patient outcomes
Perineum
Pregnancy
Prospective Studies
Statistical analysis
Statistical tests
Success
Surveillance
Tertiary
Tertiary Care Centers
Vacuum
Vacuum Extraction, Obstetrical - adverse effects
Vacuum Extraction, Obstetrical - statistics & numerical data
Vagina
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Halldórsdóttir, Erna
Kvile, Janne
Berntzen, Line Sissel Dahlgaard
Jacobsen, Anne Flem
description Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of
doi_str_mv 10.1371/journal.pone.0259926
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Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of &lt;0.05 was considered statistically significant. Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p&lt; 0.001). In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. 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Halldórsdóttir, Erna ; Kvile, Janne ; Berntzen, Line Sissel Dahlgaard ; Jacobsen, Anne Flem</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c665t-299e41ebdd1af7b4464bbb18480b84baf8cac4065ed7f36de53cb56a85a0c1893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Biology and Life Sciences</topic><topic>Birth weight</topic><topic>Cesarean section</topic><topic>Cesarean Section - statistics &amp; numerical data</topic><topic>Chi square analysis</topic><topic>Chi-square test</topic><topic>Childbirth &amp; labor</topic><topic>Clinical medicine</topic><topic>Complications</topic><topic>Confidence intervals</topic><topic>Failure rates</topic><topic>Female</topic><topic>Gestational age</topic><topic>Gynecology</topic><topic>Health risks</topic><topic>High vacuum</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Injuries</topic><topic>Labor</topic><topic>Labor Onset</topic><topic>Maternal Age</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Morbidity</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Obstetric Labor Complications - epidemiology</topic><topic>Obstetric Labor Complications - etiology</topic><topic>Obstetrical Forceps</topic><topic>Obstetrics</topic><topic>Patient outcomes</topic><topic>Perineum</topic><topic>Pregnancy</topic><topic>Prospective Studies</topic><topic>Statistical analysis</topic><topic>Statistical tests</topic><topic>Success</topic><topic>Surveillance</topic><topic>Tertiary</topic><topic>Tertiary Care Centers</topic><topic>Vacuum</topic><topic>Vacuum Extraction, Obstetrical - adverse effects</topic><topic>Vacuum Extraction, Obstetrical - statistics &amp; 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Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of &lt;0.05 was considered statistically significant. Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p&lt; 0.001). In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34784382</pmid><doi>10.1371/journal.pone.0259926</doi><tpages>e0259926</tpages><orcidid>https://orcid.org/0000-0003-4160-3978</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
ispartof PloS one, 2021-11, Vol.16 (11), p.e0259926-e0259926
issn 1932-6203
1932-6203
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source NORA - Norwegian Open Research Archives; Publicly Available Content Database; PubMed Central(OpenAccess)
subjects Adult
Biology and Life Sciences
Birth weight
Cesarean section
Cesarean Section - statistics & numerical data
Chi square analysis
Chi-square test
Childbirth & labor
Clinical medicine
Complications
Confidence intervals
Failure rates
Female
Gestational age
Gynecology
Health risks
High vacuum
Hospitals, University
Humans
Injuries
Labor
Labor Onset
Maternal Age
Medical instruments
Medicine
Medicine and Health Sciences
Methods
Morbidity
Neonates
Newborn babies
Obstetric Labor Complications - epidemiology
Obstetric Labor Complications - etiology
Obstetrical Forceps
Obstetrics
Patient outcomes
Perineum
Pregnancy
Prospective Studies
Statistical analysis
Statistical tests
Success
Surveillance
Tertiary
Tertiary Care Centers
Vacuum
Vacuum Extraction, Obstetrical - adverse effects
Vacuum Extraction, Obstetrical - statistics & numerical data
Vagina
title Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications
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