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

Abstract

Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure.

Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥ 34 w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3–4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb’s palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes.

Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity – with an odds ratio (OR) of 1.82 (95% CI = 1.11–2.98, p = 0.018), epidural anesthesia (OR 1.99, CI = 1.42–2.80, p < 0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI = 1.35–2.54, p < 0.001), prolonged second stage as indication for VE (OR 1.54, CI = 1.11–2.15, p = 0.010), cup detachment (OR 1.66, CI = 1.18–2.34, p = 0.004), increasing procedure duration (OR 1.07 for every additional minute, CI = 1.03–1.11, p < 0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI = 2.33–5.02, p < 0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI = 0.43–0.89, p = 0.010).

Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD).

Zusammenfassung

Einleitung Die Vakuumextraktion (VE), umgangssprachlich Saugglockenentbindung genannt, ist ein wichtiges Verfahren der modernen Geburtsheilkunde. Ihr Einsatz hat aber manchmal unerwünschte Folgen für Mutter und Kind, die mit lebenslangen Behinderungen einhergehen können. Ziel dieser Studie war es, die potenziellen Risikofaktoren für unerwünschte Outcomes zu beschreiben, die, retrospektiv gesehen, den Arzt/die Ärztin von einer VE-Entbindung abgehalten hätten.

Material und Methoden Untersucht wurde eine retrospektive Kohort von 3331 Einlingsschwangerschaften, die in der ≥ 34. SSW mithilfe der VE entbunden wurden. Bei 263 dieser Entbindungen (7,9%) kam es zu einem VE-bedingten unerwünschten Outcome für Mutter oder Kind, das als Auftreten von einem oder mehreren der nachfolgend aufgelisteten Ereignisse definiert wird: Dammriss 3.–4. Grades, subgaleatisches Hämatom, intrakraniale Blutung, Schulterdystokie, Schlüsselbeinbruch, kindliche Plexusparese oder Oberarmfraktur. Bei 3068 Entbindungen (92,1%) kam es zu keinen VE-bedingten unerwünschten Outcomes. Die 2 Gruppen wurden miteinander verglichen, um potenzielle Risikofaktoren für VE-bedingte unerwünschte Folgen auszumachen.

Ergebnisse Die multivariable Regressionsanalyse fand 7 unabhängige Risikofaktoren für VE-bedingte unerwünschte fetale oder maternale Outcomes: Nulliparität – mit einer Odds Ratio (OR) von 1,82 (95%-KI 1,11–2,98, p = 0,018), Epiduralanästhesie (OR 1,99, 95%-KI 1,42–2,80, p < 0,001), Mityvac-Ventouse-(MV-)Saugglocke (OR 1,86, 95%-KI 1,35–2,54, p < 0,001), ausgedehnte Austreibungsphase als Indikation für eine VE (OR 1,54, 95%-KI 1,11–2,15, p = 0,010), Ablösung der Saugglocke (OR 1,66, 95%-KI = 1,18–2,34, p = 0,004), lange VE-Entbindungsdauer (OR 1,07 für jede zusätzliche Minute, 95%-KI 1,03–1,11, p < 0,001) sowie ein hohes neonatales Geburtsgewicht (OR 3,42 für jedes zusätzliche Kg, 95%-KI 2,33–5,02, p < 0,001). Schutzfaktor bei der Geburt war eine vordere Hinterhauptslage des Kindes (VoHHL) (OR 0,62, 95%-KI 0,43–0,89, p = 0,010).

Schlussfolgerungen VE-bedingte unerwünschte Outcomes waren mit klinischen Merkmalen wie Nulliparität, Epiduralanästhesie, MV-Saugglocke, ausgedehnte Austreibungsphase als Indikation für eine VE, Ablösung der Saugglocke, langer VE-Entbindungsdauer sowie hohem neonatalen Geburtsgewicht korreliert. VoHHL des Kindes war ein Schutzfaktor. Diese Informationen sollten dem medizinischen Personal als Entscheidungshilfe dienen, wenn es um die Entscheidung für eine VE- oder eine Kaiserschnittentbindung geht.

Schlüsselwörter

Vakuumentbindung - Vakuumextraktion - vakuumbedingte unerwünschte Outcomes - vakuumbedingte mütterliche Komplikationen - vakuumbedingte neonatale Komplikationen

Keywords

vacuum-assisted delivery - vacuum extraction - adverse outcomes of vacuum delivery - maternal complications of vacuum delivery - neonatal complications of vacuum delivery

Publikationsverlauf

Eingereicht: 29. Januar 2022

Angenommen nach Revision: 16. Juli 2022

Artikel online veröffentlicht:
07. September 2022

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