Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?

Cohen, Gal; Schreiber, H; Ram, Hila Shalev; Ovadia, Michal; Shechter‐Maor, Gil; Biron‐Shental, Tal

doi:10.1055/a-1904-6025

Cited by 3 publications

(3 citation statements)

References 45 publications

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“…These characteristics were more frequently displayed in the GDM-IPH group; therefore, this could explain the higher rate of vaginal operative delivery. This goes along with a recent analysis, that was able to demonstrate an association of vacuum extraction and nulliparity [25]. Ramos et al examined women requiring operative delivery assistance and found a decreased likelihood of vaginal operative delivery in women with pre-pregnancy obesity [26].…”

Section: Discussionmentioning

confidence: 64%

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

Balke

Weid

Fangmann

et al. 2023

JCM

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Objectives and Background: Gestational diabetes (GDM) is a common pregnancy complication defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1 h 50 g oGCT (oral glucose challenge test) followed by a 2 h 75 g oGTT if the first was pathological. This analysis examines the correlation of 75 g oGTT glucose levels and fetomaternal outcome. Methods: Data from 1664 patients from a gestational diabetes consultation clinic at the Charité University Hospital in Berlin, Germany, were analyzed retrospectively from 2015 to 2022. The 75 g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values, after glucose application. These subtypes were compared based on their baseline characteristics as well as fetal and maternal outcome. Results: GDM-IFH and GDM-CH women displayed higher pre-conceptional BMI and required insulin therapy more frequently (p < 0.001). The GDM-IFH group was at higher risk of having a primary cesarean section (p = 0.047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p = 0.013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p < 0.001) and birth weight percentiles (p < 0.001) and were at increased risk of being large for gestational age (LGA) (p = 0.004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p = 0.027) or with low fetal weight <30th percentile (p = 0.003). Conclusion: This analysis shows a strong association between the glucose response pattern in the 75 g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach to prenatal care after a GDM diagnosis.

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Section: Discussionmentioning

confidence: 64%

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

Balke

Weid

Fangmann

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…However, the odds of a vaginal operative delivery were significantly increased if women were underweight and/or nulliparous. This goes along with a recent analysis, that was able to demonstrate an association of vacuum extraction and nulliparity (25). Ramos et al examined women requiring operative delivery assistance and found a decreased likelihood of vaginal operative delivery in women with prepregnancy obesity (26).…”

Section: Figurementioning

confidence: 63%

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

Balke¹,

Weid²,

Fangmann³

et al. 2023

Preprint

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Objectives and Background: Gestational diabetes (GDM) is a common pregnancy complication, defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1-hour 50g oGCT (oral glucose challenge test) followed by a 2-hour 75g oGTT if the first was pathological. This analysis examines the correlation of 75g oGTT glucose levels and fetomaternal outcome. Methods: Data of 1664 patients from a gestational diabetes consultation clinic at the Charité University hospital in Berlin, Germany, were analyzed retrospectively from 2015 until 2022. The 75g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1-hour and 2-hour values after glucose application. These subtypes were compared regarding baseline characteristics as well as fetal and maternal outcome. Results: GDM-IFH and GDM-CH women displayed higher preconceptional BMI and required insulin therapy more frequently (p<0,001). The GDM-IFH group was at higher risk of having a primary cesarean section (p=0,047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p=0,013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p<0,001) and birth weight percentiles (p<0,001) and were at increased risk of being large for gestational age (LGA) (p=0,004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p=0,027) or with low fetal weight <30th percentile (p=0,003). Conclusion: This analysis shows a strong association between glucose response pattern in the 75g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach in prenatal care after a GDM diagnosis.

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“…The key distinctions between the two are the vacuum mechanism (handheld pump vs. conventional vacuum) and the traction pole (flexible in the Kiwi and rigid in the Mityvac). Recent data suggest that the use of the Kiwi OmniCup minimizes feto-maternal birth trauma, as compared to the Mityvac cup [19,20]. Failure rates using the Kiwi OmniCup vary [21][22][23], and are reported at around 1.4% in a previous publication from our institution [24].…”

Section: Introductionmentioning

confidence: 86%

The Impact of Total Deceleration Area and Fetal Growth on Neonatal Acidemia in Vacuum Extraction Deliveries

et al. 2023

Self Cite

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We aimed to investigate the correlation between total deceleration area (TDA), neonatal birthweight and neonatal acidemia in vacuum extractions (VEs). This is a retrospective study in a tertiary hospital, including VE performed due to non-reassuring fetal heart rate (NRFHR). Electronic fetal monitoring during the 120 min preceding delivery was interpreted by two obstetricians who were blinded to neonatal outcomes. TDA was calculated as the sum of the area under the curve for each deceleration. Neonatal birthweights were classified as low (<2500 g), normal (2500–3999 g) or macrosomic (>4000 g). A total of 85 VEs were analyzed. Multivariable linear regression, adjusted for gestational age, nulliparity and diabetes mellitus, revealed a negative correlation between TDA in the 60 min preceding delivery and umbilical cord pH. For every 10 K increase in TDA, the cord pH decreased by 0.02 (p = 0.038; 95%CI, −0.05–0.00). The use of the Ventouse-Mityvac cup was associated with a 0.08 decrease in cord pH as compared to the Kiwi OmniCup (95%CI, −0.16–0.00; p = 0.049). Low birthweights, compared to normal birthweights, were not associated with a change in cord pH. To conclude, a significant correlation was found between TDA during the 60 min preceding delivery and cord pH in VE performed due to NRFHR.

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Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?

Cited by 3 publications

References 45 publications

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM)

The Impact of Total Deceleration Area and Fetal Growth on Neonatal Acidemia in Vacuum Extraction Deliveries

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