Choosing between bad, worse and worst: what is the preferred mode of delivery for failure of the second stage of labor?

Hendler, Israel; Kirshenbaum, Michal; Barg, Moshe; Kees, Salim; Mazaki‐Tovi, Shali; Moran, Orit; Kalter, Anat; Schiff, Eyal

doi:10.1080/14767058.2016.1228058

Cited by 14 publications

(10 citation statements)

References 8 publications

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“…Nolens et al 39 adjusted for strongest confounding factor per outcome and included: previous CS, birthweight, indication of delay, indication of fetal distress, impending uterine rupture, nulliparous and admission in second stage in their logistic regression. Bailit et al, 28 Giacchino et al, 31 and Hendler et al 34 did not specify for which confounding factors they adjusted. All studies but one scored the maximum score with regards to the selection of data, implying that it was known whether a woman gave birth by VE or SSCS, and that neither of the maternal or neonatal outcomes mentioned above in ‘data extraction’ were already present at the onset of VE or SSCS.…”

Section: Resultsmentioning

confidence: 99%

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Thierens

Binsbergen

Nolens

et al. 2023

BJOG

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Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle-Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis:The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17-13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85-2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low-and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

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Section: Resultsmentioning

confidence: 99%

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Thierens

Binsbergen

Nolens

et al. 2023

BJOG

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“…However, short time windows in obstetric emergencies limit obstetric preparation (10). Labor-associated complications may be inevitable even if emergency conditions including fetal asphyxia, shoulder dystocia, and umbilical cord compression are detected by intrapartum ultrasound (4,11).…”

Section: Introductionmentioning

confidence: 99%

Nomogram based on the final antepartum ultrasound features before delivery for predicting failed spontaneous vaginal delivery in nulliparous women

et al. 2023

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BackgroundAccurate identification of nulliparous women with failed spontaneous vaginal delivery (SVD) is crucial to minimize the hazards associated with obstetrical intervention (OI). While abnormal labor progression can be identified with intrapartum ultrasonography, labor-related complications may be unavoidable due to the limited time window left to the obstetrician. Antepartum ultrasound enables sufficient obstetric planning. However, there is typically a longer gap between ultrasound assessment and delivery that often lowers the prediction accuracy compared to intrapartum ultrasonography.ObjectiveIn this study, antepartum ultrasound assessment was included to each fetal ultrasound examination after 36 weeks of gestation until the onset of labor. We aim to establish a nomogram to predict the likelihood of failed SVD in nulliparous women using the last antepartum ultrasound findings before labor beginning.MethodsOf the 2,143 nulliparous women recruited, 1,373 were included in a training cohort and 770 in a validation cohort, based on their delivery date. Maternal and perinatal characteristics, as well as perinatal ultrasound parameters were collected. In the training cohort, the screened correlates of SVD failure were used to develop a nomogram for determining whether a nulliparous woman would experience SVD failure. This model was validated in both training and validation cohorts.ResultsSVD failure affected 217 nulliparous women (10.13%). In the training cohort, SVD failure was independently associated with BMI [odds ratio (OR) = 1.636], FHC (OR = 1.194), CL (OR = 1.398), and PCA (OR = 0.824) (all P < 0.05). They constituted a nomogram to estimate the individual risk of SVD failure. The model obtained clinical net benefits in both the training and validation cohorts and was validated to present strong discrimination and calibration.ConclusionThe developed nomogram based on the last antepartum ultrasound findings may be helpful in avoiding OI and its related complications by assessing the likelihood of a failed SVD in nulliparous women.

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“…All these types of births have pros and cons, and the chosen mode of delivery may not suit with the characteristics of the mother. Choosing the wrong mode of delivery may pose different risks, such as fetal termination, excessive bleeding, breathing problems for the baby, and the like [2].…”

Section: Introductionmentioning

confidence: 99%

Exploring Machine Learning Algorithms to Find the Best Features for Predicting Modes of Childbirth

Islam¹,

Mahmud²,

Khan³

et al. 2021

IEEE Access

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Choosing between bad, worse and worst: what is the preferred mode of delivery for failure of the second stage of labor?

Abstract: Operative vaginal delivery was associated with reduced postpartum infection compared to cesarean section. Forceps delivery was associated with reduced risk for adverse neonatal outcome compared to vacuum extraction, with no increase in the risk of composite maternal complications.

Cited by 14 publications

References 8 publications

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Vacuum extraction or caesarean section in the second stage of labour: A systematic review

Nomogram based on the final antepartum ultrasound features before delivery for predicting failed spontaneous vaginal delivery in nulliparous women

Exploring Machine Learning Algorithms to Find the Best Features for Predicting Modes of Childbirth

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