Department of Obstetrics and Gynecology, Mulago National Referral Hospital, Kampala, Uganda.
Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands.
Int J Gynaecol Obstet. 2018 Jul;142(1):28-36. doi: 10.1002/ijgo.12500. Epub 2018 Apr 20.
To compare maternal and perinatal outcomes between vacuum extraction and second-stage cesarean delivery (SSCD).
The present observational cohort study was conducted among women with term vertex singleton pregnancies who underwent vacuum extraction or SSCD at Mulago National Referral Hospital, Kampala, Uganda, between November 25, 2014, and July 8, 2015. Severe maternal outcomes (mortality, uterine rupture, hysterectomy, re-laparotomy) and perinatal outcomes (mortality, trauma, low Apgar score, convulsions) were compared between initial delivery mode.
Among 13 152 deliveries, 358 women who underwent vacuum extraction and 425 women who underwent SSCD were enrolled in the study. No maternal deaths occurred after vacuum extraction versus five deaths from complications of SSCD. Vacuum extraction was associated with less severe maternal outcomes compared with SSCD (3 [0.8%] vs 18 [4.2%]; adjusted odds ratio [aOR] 0.24, 95% confidence interval [CI] 0.07-0.84). Fetal death during the decision-to-delivery interval was also less common in the vacuum extraction group (3 [0.9%] vs 18 [4.4%]; aOR 0.24, 95% CI 0.07-0.84); however, the perinatal mortality rate did not differ between the vacuum extraction and SSCD groups (29 [8.4%] vs 45 [11.0%], respectively; aOR 0.83, 95% CI 0.49-1.41). One infant in each group exhibited neurodevelopmental anomalies at 6 months.
Vacuum extraction had better maternal outcomes and equivalent perinatal outcomes compared with SSCD. These findings encourage re-introduction of vacuum extraction.
比较真空吸引术与第二产程剖宫产（SSCD）的母婴围生结局。
本观察性队列研究于 2014 年 11 月 25 日至 2015 年 7 月 8 日在乌干达坎帕拉的穆拉戈国家转诊医院进行，纳入行真空吸引术或 SSCD 的足月头位单胎妊娠产妇。比较初始分娩方式之间的严重产妇结局（死亡率、子宫破裂、子宫切除术、再次剖腹术）和围生儿结局（死亡率、创伤、低 Apgar 评分、惊厥）。
在 13 152 例分娩中，358 例接受真空吸引术的产妇和 425 例接受 SSCD 的产妇纳入研究。真空吸引术后无产妇死亡，而 SSCD 术后有 5 例死于并发症。与 SSCD 相比，真空吸引术与较少的严重产妇结局相关（3[0.8%]例 vs 18[4.2%]例；调整后的优势比[aOR]0.24，95%置信区间[CI]0.07-0.84）。在决策至分娩间隔期间，胎儿死亡也较少发生在真空吸引术组（3[0.9%]例 vs 18[4.4%]例；aOR 0.24，95% CI 0.07-0.84）；然而，真空吸引术组与 SSCD 组的围生儿死亡率无差异（分别为 29[8.4%]例和 45[11.0%]例；aOR 0.83，95% CI 0.49-1.41）。两组各有 1 例婴儿在 6 个月时出现神经发育异常。
与 SSCD 相比，真空吸引术具有更好的母婴结局和等效的围生儿结局。这些发现鼓励重新引入真空吸引术。
