Failed Vacuum Extraction: Maternal Risk Factors and Pregnancy Outcome

Sheiner, Eyal; Shoham‐Vardi, Ilana; Silberstein, Tali; Hallak, Mordechai; Katz, Miriam; Mazor, Moshe

doi:10.1097/00006254-200203000-00009

Cited by 24 publications

(37 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Fetal macrosomia is an important risk factor for prolonged and operative deliveries [17,18]. Moreover, fetal macrosomia contributes greatly to the occurrence of shoulder dystocia [19][20][21][22], which was also more frequent among males.…”

Section: Discussionmentioning

confidence: 99%

Gender Does Matter in Perinatal Medicine

Sheiner¹,

Levy

Katz³

et al. 2004

Fetal Diagn Ther

Self Cite

155

114

View full text Add to dashboard Cite

Objective: To investigate complications and outcome of pregnancies with male and female fetuses. Methods: A population-based study comparing all singleton deliveries between the years 1988 and 1999 was performed. We compared pregnancies with male vs. female fetuses. Patients with a previous cesarean section (CS) were excluded from the study. Statistical analyses with the Mantel-Haenszel technique and multiple logistic regression models were performed to control for confounders. Results: During the study period there were 55,891 deliveries of male and 53,104 deliveries of female neonates. Patients carrying male fetuses had higher rates of gestational diabetes mellitus (OR = 1.1; 95% CI 1.01–1.12; p = 0.012), fetal macrosomia (OR = 2.0; 95% CI 1.8–2.1; p < 0.001), failure to progress during the first and second stages of labor (OR = 1.2; 95% CI 1.1–1.3; p < 0.001 and OR = 1.4; 95% CI 1.3–1.5; p < 0.001, respectively), cord prolapse (OR = 1.3; 95% CI 1.1–1.6; p = 0.014), nuchal cord (OR = 1.2; 95% CI 1.1–1.2; p < 0.001) and true umbilical cord knots (OR = 1.5; 95% CI 1.3–1.7; p < 0.001). Higher rates of CS were found among male compared with female neonates (8.7 vs. 7.9%; OR = 1.1; 95% CI 1.06–1.16; p < 0.001). Using three multivariate logistic regression models and controlling for birth weight and gestational age, male gender was significantly associated with non-reassuring fetal heart rate patterns (OR = 1.5; 95% CI 1.4–1.6; p < 0.001), low Apgar scores at 5 min (OR = 1.5; 95% CI 1.3–1.8; p < 0.001) and CS (OR = 1.2; 95%CI 1.2–1.3; p < 0.001). Controlling for possible confounders like gestational diabetes, cord prolapse, failed induction, nonprogressive labor, fetal macrosomia, nuchal cord and true umbilical cord knots using the Mantel-Haenszel technique did not change the significant association between male gender and CS. Conclusion: Male gender is an independent risk factor for adverse pregnancy outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Gender Does Matter in Perinatal Medicine

Sheiner¹,

Levy

Katz³

et al. 2004

Fetal Diagn Ther

Self Cite

155

114

View full text Add to dashboard Cite

show abstract

“…In two recent studies, performed at the Soroka University Medical Center, a birth weight 14,000 g was determined to be an independent risk factor for labor dystocia and thus for CS and also as a risk factor for failure of instrumental delivery [8,9].…”

Section: Introductionmentioning

confidence: 99%

To Induce or Not to Induce Labor: A Macrosomic Dilemma

Simhayoff

Sheiner

Levy

et al. 2004

Gynecol Obstet Invest

Self Cite

View full text Add to dashboard Cite

We assessed the effect of labor induction among parturients carrying macrosomic fetuses on the risk of a cesarean section (CS). The study population consisted of consecutive women with singleton fetuses weighing ≧4,000 g, delivered between 1988 and 1999. A comparison was made between parturients who delivered after labor induction and those who delivered without labor induction. The Mantel-Haenszel procedure was used to obtain the weighted odds ratios while controlling for confounding variables. During the study period, 4,755 women delivered macrosomic newborns in our institution. In 20% of the women (n = 951) labor was induced, while 80% of them (n = 3,804) delivered without labor induction. The women who delivered after labor induction were more likely to be nulliparous (18.0 vs. 10.0%; p < 0.001). In addition, these women had significantly higher rates of gestational diabetes (23.3 vs. 10.7%; p < 0.001), hypertensive disorders (10.1 vs. 5.3%; p < 0.001), hydramnios (17.4 vs. 9.9%; p < 0.001), and oligohydramnios (2.1 vs. 0.2%; p < 0.001). The CS rate was significantly higher among the patients who delivered after labor induction as compared with those in whom labor was not induced (17.8 vs. 11.9%; odds ratio 1.6, 95% confidence interval 1.3–1.9, p < 0.001). Stratified analysis using the Mantel-Haenszel technique was performed to control for confounders such as gestational diabetes, hypertensive disorders, previous CS, hydramnios, oligohydramnios, and nulliparity. None of these variables changed the significant association between induction of labor and CS. The induction of labor among women carrying macrosomic fetuses was found to be an independent risk factor for a CS.

show abstract

“…[13][14][15][16][17] However, rotation of the fetal head is considered a controversial procedure by many obstetricians, despite data showing low complication rates. [18][19][20] Although more experienced accoucheurs had the highest unadjusted rates of unsuccessful instrumental attempts, this is likely to be because more difficult deliveries are usually handled by more senior obstetricians. After adjusting for birth weight and the need for rotation, junior obstetrics trainees had the highest adjusted rates of unsuccessful instrumental delivery, indicating that increased training and experience are imperative.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the likelihood of vacuum delivery success

Shinde¹,

Karale²,

Shekhawat³

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Background: Instrumental or assisted vaginal birth is commonly used to expedite birth, for the benefit of either mother, baby or both. Objective of present study was to evaluate risk factors for unsuccessful vacuum delivery when variability between individual accoucheurs is taken into account.Methods: We conducted a retrospective cohort study of attempted 687 vacuum deliveries over a 10-year period (2008–2017 inclusive) in a tertiary care center at Smt. Kashibai Navale Medical College and General Hospital, Narhe to account for inter-accoucheur variability, we matched unsuccessful deliveries (cases) with successful deliveries (controls) by the same operators. Multivariate logistic regression was used to compare successful and unsuccessful vacuum deliveries.Results: During the study period of 10 years, there were 29861 deliveries, of which 19831 (66.4%) were vaginal deliveries. 8802 (29.47%) were cesarean deliveries and 1228 (4.1%) were instrumental deliveries. Among instrumental deliveries, 687 (56%) were vacuum deliveries and 541 (44%) were forceps deliveries. Six hundred and eighty-seven ventouse deliveries of vertex presenting, single, term infants were attempted, of which 38 were unsuccessful (5.5%). Increased birth weight (OR=1.11 p<0.001), second-stage duration (OR=1.01 p<0.001), rotational delivery (OR=1.52 p<0.05) and use of ventouse versus forceps (OR=1.33 p<0.05) were associated with unsuccessful outcome. When inter-accoucheur variability was controlled for, instrument selection and decision to rotate were no longer associated with vacuum delivery success. More senior accoucheurs had higher rates of unsuccessful deliveries (12% v. 5%, p<0.05), but undertook more complicated cases. Cesarean delivery in the second stage without prior attempt at ventouse delivery was associated with higher birth weight (OR=1.07 p<0.001), increased maternal age (OR=1.03 p<0.01), and epidural analgesia (OR=1.46 p<0.001).Conclusions: Careful selection of cases and adequate training of post graduate students during residency under direct supervision of senior experienced obstetrician can reduce the rate of failed vacuum delivery and related complications Results suggest that birth weight and head position are the most important factors in successful vacuum delivery, whereas the influence of patient selection and rotational delivery appear to be operator-dependent. Risk factors for lack of vacuum delivery success are distinct from risk factors for requiring vacuum delivery, and these should not be conflated in clinical practice.

show abstract

Failed Vacuum Extraction: Maternal Risk Factors and Pregnancy Outcome

Cited by 24 publications

References 0 publications

Gender Does Matter in Perinatal Medicine

Gender Does Matter in Perinatal Medicine

To Induce or Not to Induce Labor: A Macrosomic Dilemma

Factors influencing the likelihood of vacuum delivery success

Contact Info

Product

Resources

About