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Operative Obstetrics

Poster Session 3

(834) Vacuum delivery for "Maternal Exhaustion" has distinctive characteristics.

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Prolonged labor can be physically and emotionally exhausting and is associated with an increased risk of vacuum extraction (VE). Effective pushing and cooperation throughout the VE procedure are crucial for a favorable outcome. We aimed to characterize women at risk for VE indicated for "Maternal Exhaustion."

Study Design: A retrospective cohort study of all singletons, term VEs in a tertiary center between 2011 and 2022. Patients were allocated into two groups based on the indication for VD, exhaustion (group 1) versus non-exhaustion (group 2). Exhaustion was based on the operator's discretion. The primary outcome was to investigate potential risk factors for exhaustion before VE.

Results:

We analyzed 2,950 VEs; 819 (27.8%) were indicated for exhaustion and 2,131 (72.2%) for non-exhaustion (Table 1). The features of the VE procedure, such as the number of pulls or detachments and the duration of the procedure, were not different between the groups. In univariate analysis, exhausted mothers were more likely to be nulliparous (75% vs. 71%, p=0.028), have diabetes in pregnancy (7.7% vs. 5.4%, p=0.047), use regional anesthesia (92.4% vs. 89.1%, p=0.006), have a longer duration of premature rupture of membranes [9.8 h (5.5-19.6) vs. 8.3 h (4.12-15.7), p< 0.001], longer second-stage duration (2.86 h ± 1.2 vs. 2.54 h ± 1.3, p< 0.001), and spend an extended time in the labor-ward [15.8 h (11.0-22.2) vs. 13.4 h (9.4-19.4), p< 0.001]. Using multivariable logistic regression, the duration of the second stage was the most statistically significant variable to predict "Maternal Exhaustion." as an indication for VE, an increment of 27.4% with every hour in the second stage (OR 1.274 [95% CI 1.146-1.416]).

Conclusion:

Longer second-stage duration and extended time in the delivery room increase the risk of VE for the indication of maternal exhaustion. Better identification and support for prone gravidas may decrease VE rates and improves the birth experience.