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Vacuum manufacturers recommend against utilizing their devices beyond three pop-offs, however there is a paucity of evidence to support this recommendation. Our objective was to examine whether the number of pop-offs in a vacuum-assisted delivery was associated with adverse neonatal outcomes. STUDY DESIGN: This is a retrospective cohort of women who underwent a trial of a vacuum-assisted vaginal delivery at a single tertiary care institution between October 2005 and June 2014. Maternal and fetal factors associated with the number of pop-offs were examined in bivariable analyses. Multivariable analyses were performed to determine the independent association of the number of pop-offs with adverse neonatal outcomes. RESULTS: Of the 1838 women who met inclusion criteria, 1296 (70.5%) had no pop-offs, 241 (13.1%) had one pop-off, 129 (7.0%) had two pop-offs, and 74 (4.0%) had three or more pop-offs. Neonatal scalp/facial lacerations, intracranial hemorrhage, seizures, central nervous system depression, and NICU admission were all associated with the number of pop-offs in bivariable analyses. In multivariable analyses, compared to no pop-offs, having vacuum pop-offs was associated with an increased risk of adverse outcomes, however there was not a consistent increase in adverse events associated with three or more pop-offs (with aOR and 95% CI after adjusting for nulliparity, chorioamnionitis, arrest/exhaustion indication for operative delivery, and occiput posterior presentation presented in the Table). CONCLUSION: While having vacuum pop-offs in a vacuum-assisted delivery was associated with an increased risk of adverse neonatal outcomes, there did not appear to be a dose dependent association with the number of pop-offs, thereby calling the three pop-off convention into question.

Bodies are useful instruments for understanding the reproduction of inequalities. In this article, we investigate why and how bodily, social, intimate, and physical boundaries are crossed and what this can tell us about individual and social bodies. We unpack how seeing and being seen, touching and being touched, or feeling and being felt are conditioned in very particular ways by the broader political economy. Participants in this ethnographic research in Mexico used the term manitas to describe how they trained their senses (hands, ears, eyes) during medical practice; how they learned through practice on the bodies of less‐agentive populations (female, raced, or impoverished); and how they crossed intimacy, structural, and physical boundaries through what we term somatic translation: seeing others’ bodies with their own. Manitas was developed unconsciously by doctors, never explicitly taught or learned in practice, reproducing social difference. These forms of learning highlight a friction between the violence of knowing and the importance of touch as a legitimate mode of care. This form of tactile and sensorial learning entails not only a form of boundary crossing that is medically useful, but it is also a form of boundary crossing that surfaces social inequalities by taking advantage of them. [hospital ethnography, anthropology of reproduction, embodiment, social boundaries, Mexico]

INTRODUCTION: Cerclage is one of the interventions to prevent spontaneous preterm birth (sPTB). This study aimed to identify predictive factors of cerclage success in preventing sPTB. METHODS: Retrospective study of singleton pregnancy at high risk of sPTB in University of Illinois at Chicago between 2013 and 2017. Baseline characteristics, duration of pregnancy, pregnancy outcomes and other predictive factors were analyzed using χ2, student t test, and multiple logistic regression analysis. RESULTS: Of the 310 women identified, 90 (29%) had rescue cerclage, and 65 (21%) had prophylactic cerclage. Most statistically significant predictors of sPTB of rescue cerclage were insertions at 17–20 weeks, aOR 2.26 (95% CI: 1.47–3.50, P<.0001), and at 21–22 weeks, aOR 1.81 (95% CI: 1.15–2.87, P<.0001). Cerclages placed at CL <10 mm was associated with increased likelihood of sPTB, aOR 1.60 (95% CI: 1.10–2.34, P<.0001). Cervical length at 21–25 mm and cerclage at GA <16 weeks were associated with decreased rate of sPTB, aOR 0.40 (95% CI: 0.26–0.61, P<.0001), and aOR 0.26 (95% CI: 0.16–0.40, P<.0001). Except for indomethacin in prophylactic cerclage, cervical dilatation, funneling, presence of sludge, prior sPTB, vaginal infections and use of 17-OHPC, these were not statistically significant in preventing sPTB. CONCLUSION: The success of cerclage in the prevention of sPTB depends on several factors. The most predictive factors were the degree of short cervix and earlier GA at cerclage placement.

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