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Q&A

Labor

Poster Session 3

(748) Can Failed Vacuum Extraction Be Predicted?

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Itamar Gilboa, MD

    Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
    Tel Aviv, Israel

    • Coauthor(s)

  • DG

    Daniel Gabbai, MD,MPH

    Tel Aviv Sourasky Medical Center
    Tel Aviv, HaMerkaz, Israel

  • Emmanuel Attali, MD

    Lis Maternity Hospital, Department of Obstetrics and Gynecology, Sourasky Medical Center, Tel Aviv University
    Tel Aviv, Israel

  • YY

    Yariv Yogev, MD

    Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center
    Tel Aviv, Israel, Israel

  • AL

    Anat Lavie, MD

    Lis Hospital for Women's Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Israel, Israel

Objective: Objective: We aimed to determine risk factors for failed vacuum delivery among singleton pregnancies and to develop a prediction model.

Study Design:

Methods: A retrospective cohort study between the years 2011- 2023, in a single university-affiliated medical center, with approximately 12,500 deliveries annually, was conducted. The study population included singleton pregnancies with a trial of vacuum extraction delivery and was divided into two groups; failed vacuum extraction (study group), defined as cases with an extraction duration exceeding 20 minutes or more than 2 cup detachments, leading to an urgent cesarean delivery (CD). The control group was comprised from women who had a successful vacuum extraction delivery.

Pregnancy characteristics and outcomes were compared.

Results:



Results:


  1. Overall during the study period there were 133,024 deliveries, of them, 9,581 (7.2%) by vacuum extraction.

  2. The rate of failed vacuum extraction was 186/9,581 (1.9%).

  3. Multivariate analysis revealed an increased risk for a failed vacuum delivery associated  with the following factors: patient's height < 160 cm. (OR=2.7, 95%CI [1.5-4.8], p< 0.001), induction of labor (OR=2.1, 95% CI [1.2-3.8], p=0.013), presenting part station < Sp+2 (OR=2.4, 95%CI [1.3-4.4], p=0.004), length of 2nd stage of delivery > 3.5 hours (OR=2.2, 95%CI [1.1-4.4], p=0.03), birthweight > 3750 gr (OR=2.4, 95%CI [1.2-5.1], p=0.02), and male gender (OR=2.1, 95%CI [1.1-4.0], p=0.024).

  4. Newborns in the study group had increased rates of NICU hospitalization (20.4% vs. 5.6%, p< 0.001), subgaleal hematoma (5.4% vs. 0.3%, p< 0.001), and neonatal death (0.5% vs. 0.1%, p=0.015).

  5. The prediction score model, incorporating these risk factors, demonstrated predictive performance with an AUC of 0.727 (95%CI 0.66-0.80), p-value < 0.001).



Conclusion:

Conclusion:  Using a prediction model for failed vacuum delivery may assist for caregivers to identify high risk patients for complicated delivery.