Cohen Gal, Schreiber Hanoch, Shalev Ram Hila, Ovadia Michal, Shechter-Maor Gil, Biron-Shental Tal
Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Geburtshilfe Frauenheilkd. 2022 Sep 7;82(11):1274-1282. doi: 10.1055/a-1904-6025. eCollection 2022 Nov.
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. 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. 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). 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).
真空吸引术（VE）是现代产科中的一项重要助产方式，但有时会导致产妇或新生儿出现不良结局，这些不良结局可能会造成终身残疾。我们旨在确定不良结局的潜在风险因素，回顾这些因素可使医生避免采用该操作。对3331例单胎妊娠、孕周≥34周且通过真空吸引术分娩的产妇进行回顾性队列研究。263例分娩（7.9%）出现了与真空吸引术相关的母婴不良结局，定义为以下一种或多种情况：会阴Ⅲ-Ⅳ度裂伤、帽状腱膜下血肿、颅内出血、肩难产、锁骨骨折、臂丛神经麻痹或肱骨骨折。3068例分娩（92.1%）未出现与真空吸引术相关的不良结局。对两组进行比较以确定真空吸引术不良结局的潜在风险因素。多变量回归分析发现了与真空吸引术相关的母婴不良结局的七个独立风险因素：初产妇——优势比（OR）为1.82（95%置信区间[CI]=1.11-2.98，p=0.018）、硬膜外麻醉（OR 1.99，CI=1.42-2.80，p<0.001）、Ventouse-Mityvac（VM）杯（OR 1.86，CI=1.35-2.54，p<0.001）、以第二产程延长作为真空吸引术的指征（OR 1.54，CI=1.11-2.15，p=0.010）、吸盘脱落（OR 1.66，CI=1.18-2.34，p=0.004）、操作时间增加（每增加一分钟OR为1.07，CI=1.03-1.11，p<0.001）以及新生儿出生体重增加（每增加1千克OR为3.42，CI=2.33-5.02，p<0.001）。枕前位（OA）是一个保护因素（OR 0.62，CI=0.43-0.89，p=0.010）。与真空吸引术相关的不良结局可能与临床特征相关，如初产妇、硬膜外麻醉、VM杯、以第二产程延长作为真空吸引术的指征、吸盘脱落、操作时间延长和新生儿体重增加。枕前位是一个保护因素。这些信息可能有助于医护人员就是否选择真空吸引术或剖宫产（CD）做出明智的决定。
