Vacuum extraction failure is associated with a large head circumference

Kabiri, Doron; Lipschuetz, Michal; Cohen, S. M.; Yagel, Oren; Levitt, L.; Herzberg, Shmuel; Ezra, Yossef; Amsalem, Hagai

doi:10.1080/14767058.2018.1463364

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…Nonetheless, the mean gestational age of the SGH group was similar to that of all women for whom VAD was attempted at our center during the study period (39 +4/7 vs 39 +3/7 , P = 0.16). Another limitation is that despite previous reports of an association of head circumference with difficult VAD, incomplete measurements of predelivery sonographic head circumference precluded evaluating the association of this factor with SGH occurrence. Obviously neonatal head circumference cannot be examined as a risk factor for SGH, as increased head circumference constitutes SGH diagnostic criteria.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Levin

Elchalal

Yagel

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Subgaleal hemorrhage (SGH) is a life‐threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well‐established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. Material and methods A retrospective case‐control study of women who delivered at a tertiary university‐affiliated medical center in Jerusalem, Israel, during 2009‐2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one‐to‐one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. Results In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second‐stage duration (for each 30‐minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04‐1.25; P = .006), presence of meconium‐stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52‐4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11‐2.88; P = .01), duration of VAD (for each 3‐minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66‐3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42‐8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. Conclusions Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Levin

Elchalal

Yagel

et al. 2019

Acta Obstet Gynecol Scand

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“…Successful vaginal delivery depends on appropriate entrance of the fetal head into the pelvic cavity, subsequent rotational movement of the head to enable its passage through the interspinous distance (the narrowest part of the mid-pelvis), and proper exit of the head from the pelvic outlet, extending through and below the pubic rami. Given that a large head diameter and circumference are known to be associated with higher-than-normal rates of operative vaginal delivery and cesarean delivery [13][14][15][16], it might be assumed that a small head diameter would facilitate passage of the fetus through the birth canal, resulting in significantly reduced rates of delivery complications. However, in the present study, the distribution of spontaneous vaginal and vaginal operative deliveries was similar for the microcephalic fetuses and the fetuses with a normal head circumference.…”

Section: Discussionmentioning

confidence: 99%

“…Increased biparietal diameter (BPD) measured up to 7 days before labor in term fetuses was found to be associated with a significantly higher rate of operative vaginal delivery (OVD), without adverse neonatal outcomes. Large HC was found to be an independent risk factor for OVD as well as unplanned cesarean delivery (CD) [9,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Bardin

Krispin

Salman

et al. 2021

BMC Pregnancy Childbirth

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Background We aimed to evaluate the association of isolated fetal microcephaly measured by ultrasound prior to delivery at term with mode of delivery and perinatal outcome. Methods A single-center retrospective study was conducted in 2012–2016. Fetal microcephaly was defined as head circumference > 2 standard deviations of the mean for gestational age and sex. We compared the obstetric, delivery, and outcome parameters of women in whom ultrasound performed up to 10 days prior to term delivery showed isolated fetal microcephaly (study group) or normal head circumference (reference group). Exclusion criteria were intrauterine fetal death, birthweight below the 10th percentile, and antepartum cesarean delivery for any indication. Results Of 3677 women included in the study, 26 (0.7%) had a late ultrasound finding of isolated fetal microcephaly. Baseline characteristics were similar in the two groups except for estimated fetal weight based on abdominal circumference and biparietal diameter, which was lower in the microcephaly group (3209.8 ± 557.6 vs. 2685.8 ± 420.8 g, p < .001). There was no significant between-group difference in rate of vaginal operative deliveries (11.7% vs 14.8%, respectively, p = 0.372). The study group had no intrapartum cesarean deliveries compared to 6.3% of the reference group (NS). Compared to controls, neonates in the study group were smaller (3323.2 ± 432.2 vs. 2957.0 ± 330.4 g, p < .001), with lower birthweight percentile (60.5 ± 26.5 vs. 33.6 ± 21.5%, p < .001) and were more often males (48.2 vs. 90.0%, p < .001). No significant differences were noted in perinatal outcomes between the groups, including admission to neonatal intensive care unit, intraventricular hemorrhage, 5-min Apgar score < 7, asphyxia, seizures, and sepsis. Conclusions Isolated microcephaly in term fetuses is not advantageous for a vaginal delivery, nor does it does not pose a greater than normal risk of adverse perinatal outcome.

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“…In addition we have previously described an association between large fetal and neonatal anthropomorphic measures and obstetric outcomes. These findings focused primarily on the large head circumference (HC) which was found associated with higher rates of interventional deliveries (cesarean, vacuum, failed vacuum, deliveries) [14][15][16] and higher rates of persistent occiput posterior position [17].…”

Section: Introductionmentioning

confidence: 99%

Obstetric anal sphincter injury in adolescent mothers

Chill

Lipschuetz

Atias

et al. 2021

BMC Pregnancy Childbirth

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Background Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups. Methods We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed. Results Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027). Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI. Conclusion Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.

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Vacuum extraction failure is associated with a large head circumference

Abstract: In this study, we found that large head circumference was associated with vacuum extraction failure rather than high birth weight.

Cited by 11 publications

References 18 publications

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Association of term isolated microcephaly with mode of delivery and perinatal outcome - a retrospective case-control analysis

Obstetric anal sphincter injury in adolescent mothers

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