Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2024 Apr;309(4):1281-1286. doi: 10.1007/s00404-023-06983-0. Epub 2023 Mar 3.
This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD).
This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups.
From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739).
Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.
本研究评估了真空辅助阴道分娩（VAD）与产妇年龄相关的结局。
这是一项回顾性队列研究，纳入了一家学术机构中单胎 VAD 的初产妇。研究组产妇年龄≥35 岁，对照组年龄＜35 岁。通过功效分析，我们发现每组 225 例患者可充分检测出三度和四度会阴撕裂（主要产妇结局）和脐动脉血 pH 值＜7.15（主要新生儿结局）的发生率差异。次要结局为产妇出血量、阿普加评分、杯状脱落和帽状腱膜下血肿。比较两组之间的结局。
2014 年至 2019 年，我们机构共有 13967 例初产妇分娩。总体而言，8810 例（63.1%）行正常阴道分娩，2432 例（17.4%）行器械助产，2725 例（19.5%）行剖宫产。在 11242 例阴道分娩中，10116 例（90%）产妇年龄＜35 岁，其中 2067 例（20.5%）行 VAD 成功，1126 例（10%）产妇年龄≥35 岁，其中 348 例（30.9%）VAD 成功（p＜0.001）。高级别会阴撕裂伤的发生率在年龄较大组为 6 例（1.7%），对照组为 57 例（2.8%）（p=0.259）。脐动脉血 pH 值＜7.15 的发生率相似：研究组 23 例（6.6%），对照组 156 例（7.5%）（p=0.739）。
产妇年龄较大和 VAD 与不良结局的风险增加无关。与年轻产妇相比，年龄较大的初产妇更有可能行 VAD。
