Department of Obstetrics and Gynecology, Iida Municipal Hospital, Iida, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
J Perinat Med. 2021 Feb 19;49(5):583-589. doi: 10.1515/jpm-2020-0433. Print 2021 Jun 25.
To determine the association between the number of pulls during vacuum-assisted deliver and neonatal and maternal complications.
This was a single-center observational study using a cohort of pregnancies who underwent vacuum-assisted delivery from 2013 to 2020. We excluded pregnancies transitioning to cesarean section after a failed attempt at vacuum-assisted delivery. The number of pulls to deliver the neonate was categorized into 1, 2, 3, and ≥4 pulls. We used logistic regression models to investigate the association between the number of pulls and neonatal intensive care unit (NICU) admission and maternal composite outcome (severe perineal laceration, cervical laceration, transfusion, and postpartum hemorrhage ≥500 mL).
We extracted 480 vacuum-assisted deliveries among 7,321 vaginal deliveries. The proportion of pregnancies receiving 1, 2, 3, or ≥4 pulls were 51.9, 28.3, 10.8, and 9.0%, respectively. The crude prevalence of NICU admission with 1, 2, 3, and ≥4 pulls were 10.8, 16.2, 15.4, and 27.9%, respectively. The prevalence of NICU admission, amount of postpartum hemorrhage, and postpartum hemorrhage ≥500 mL were significantly different between the four groups. Multivariable logistic regression analysis found the prevalence of NICU admission in the ≥4 pulls group was significantly higher compared with the 1 pull group (adjusted odds ratio, 3.3; 95% confidence interval, 1.4-7.8). In contrast, maternal complications were not significantly associated with the number of pulls.
Vacuum-assisted delivery with four or more pulls was significantly associated with an increased risk of NICU admission. However, the number of pulls was not associated with maternal complications.
探讨真空辅助分娩时的牵拉次数与新生儿和产妇并发症的关系。
这是一项单中心观察性研究，纳入了 2013 年至 2020 年期间行真空辅助分娩的孕妇队列。我们排除了在尝试真空辅助分娩失败后改行剖宫产的孕妇。将分娩时的牵拉次数分为 1 次、2 次、3 次和≥4 次。我们使用逻辑回归模型来研究牵拉次数与新生儿重症监护病房（NICU）入住和产妇复合结局（严重会阴裂伤、宫颈裂伤、输血和产后出血量≥500ml）之间的关系。
我们从 7321 例阴道分娩中提取了 480 例真空辅助分娩。接受 1、2、3 或≥4 次牵拉的妊娠比例分别为 51.9%、28.3%、10.8%和 9.0%。1、2、3 和≥4 次牵拉时的 NICU 入住率分别为 10.8%、16.2%、15.4%和 27.9%。四组间 NICU 入住率、产后出血量和产后出血量≥500ml 的发生率存在显著差异。多变量逻辑回归分析发现，≥4 次牵拉组的 NICU 入住率明显高于 1 次牵拉组（调整比值比，3.3；95%置信区间，1.4-7.8）。相反，牵拉次数与产妇并发症无显著相关性。
真空辅助分娩时的 4 次或以上牵拉与 NICU 入住风险增加显著相关，而与产妇并发症无关。
