Complicaciones neonatales a corto plazo de los partos por ventosa. Estudio caso-control / Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study

Introducción: El objetivo fue comparar la morbimortalidad neonatal de los partos vaginales por ventosa con los restantes partos vaginales e identificar los factores de riesgo. Material y métodos: Realizamos un estudio caso-control, retrospectivo, en un hospital con servicios de neonatología y cuidados intensivos neonatales, entre 2012 y 2016, con inclusión de 1.802 partos vaginales con ventosa, 1.802 partos eutócicos y 909 partos con fórceps. Se consideraron complicaciones menores (traumatismo de tejidos blandos, cefalohematoma, ictericia, fototerapia doble, lesión transitoria del plexo braquial) y mayores (encefalopatía hipóxico-isquémica, hemorragia intracraneal y subgaleal, convulsión, fractura craneal, lesión permanente del plexo braquial), ingreso en la Unidad de Cuidados Intensivos Neonatales y fallecimiento. Resultados: El riesgo de traumatismo de los tejidos blandos (ORa 2,4; p < 0,001), cefalohematoma (ORa 5,5; p < 0,001), ictericia (ORa 4,4; p < 0,001), fototerapia doble (ORa 2,1; p < 0,001) y lesión transitoria del plexo braquial (ORa 2,1; p = 0,006) fue mayor en los partos con ventosa en comparación con los eutócicos. El ingreso en la Unidad de Cuidados Intensivos Neonatales también fue mayor en los partos con ventosa que en los eutócicos (OR 1,9; p = 0,001). En comparación con los partos con fórceps, también se ha comprobado un mayor riesgo de traumatismo de los tejidos blandos (OR 2,1; p = 0,004), cefalohematoma (OR 2,2; p = 0,046) e ictericia (OR 1,4; p = 0,012) en los partos con ventosa. Los partos con ventosa presentaron mayor incidencia de complicaciones mayores que los restantes partos vaginales, pero la diferencia no fue significativa. Las 2 muertes ocurrieron en partos con ventosa (1,1 por 1.000). Conclusión: Las tasas de complicaciones neonatales menores fueron más altas en el parto con ventosa. Aunque las complicaciones mayores y la muerte también fueron más frecuentes, fueron poco comunes y no mostraron diferencias significativas. El parto con ventosa es una técnica con indicación obstétrica, pero que debe alertar sobre la necesidad de vigilancia de posibles complicaciones neonatales

Introduction: The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. Material and methods: We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2 control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. Results: The risk of soft tissue trauma (aOR, 2.4; P < .001), cephalohaematoma (aOR, 5.5; P < .001), jaundice (aOR, 4.4; P < .001), intensive phototherapy (aOR, 2.1; P < .001) and transient brachial plexus injury (aOR; 2.1, P = .006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P = .001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P = .046) and jaundice (OR, 1.4; P = .012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). Conclusion: The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications

Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania.

BACKGROUND: In rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing vacuum extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned. METHODS: This observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, vacuum extraction rates, and the ratio of caesareans to vacuum-assisted deliveries. RESULTS: Institutional caesarean delivery rates remained stable at about 10-11% and the vacuum extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 vacuum extraction rates in newly upgraded health centres ranged from 0.5 to 7.8%. Between 2011 and 2016, the ratio of caesareans to vacuum extractions in hospitals changed from 304 caesareans to 1 vacuum extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1. CONCLUSIONS: Reintroduction of vacuum extraction into clinical practice in primary health care facilities with task-shifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of vacuum extraction. Lessons learned are applicable to further national scale up and to other countries.

Trends in operative vaginal delivery, 2005-2013: a population-based study.

OBJECTIVE: The objectives of this study were to determine temporal trends in forceps and vacuum delivery and factors associated with operative vaginal delivery. DESIGN: Retrospective cohort. SETTING: Population-based study of US birth records. POPULATION: US births from 2005 to 2013. METHODS: This study evaluated forceps and vacuum extraction during vaginal delivery in live-born, non-anomalous singleton gestations from ≥ 36 to < 42 weeks of gestation. The primary outcomes were vacuum, forceps and overall operative delivery. Obstetric, medical and demographic characteristics associated with operative vaginal delivery were analysed. Multivariable logistic regression models were developed to determine factors associated with forceps/vacuum use. RESULTS: A total of 22 598 971 vaginal deliveries between 2005 and 2013 were included in the analysis. In all, 1 083 318 (4.8%) were vacuum-assisted and 237 792 (1.1%) were by forceps. Both vacuum and forceps deliveries decreased over the study period; vacuum deliveries decreased from 5.8% in 2005 to 4.1% in 2013, and forceps deliveries decreased from 1.4% to 0.9% during the same period. The adjusted odds ratio for forceps delivery was 0.70 (95% CI 0.69-0.72) in 2013 with 2005 as a reference. For vacuum delivery the odds ratio was 0.68 (95% CI 0.67-0.69) comparing the same years. CONCLUSION: Forceps and vacuum deliveries decreased during the study period. Low rates of operative delivery pose a challenge for resident education and may limit the degree to which women have access to alternatives to caesarean delivery. Initiatives that allow future generations of obstetricians to develop expertise in performing operative deliveries in the setting of decreased volume are an urgent resident education priority. TWEETABLE ABSTRACT: Forceps and vacuum delivery decreased significantly in the USA from 2005 to 2013.

Reason for the increasing use of vacuum extraction in Sweden: a population-based study.

OBJECTIVE: To explain the increasing rates of vacuum extraction in Sweden. DESIGN: Population-based register study. SETTING: Nationwide study in Sweden. POPULATION: A total of 589 108 primiparous women with singleton, term live births in 1992-2010. METHODS: Odds ratios with 95% confidence intervals were estimated for potential risk factors for vacuum extraction and emergency cesarean. To explain the increase in vacuum extraction over time, we successively adjusted for maternal and infant characteristics in four different models. MAIN OUTCOME MEASURES: Vacuum extraction. RESULTS: Rates of vacuum extraction increased from 11.5% in 1992 to 14.8% in 2010. The risk of vacuum extraction increased with maternal age and gestational length, but decreased with increasing maternal height. The increased use of vacuum extraction over time was partly explained by increasing maternal age and increased use of epidural anesthesia. Among women with and without epidural analgesia, the increase in vacuum extraction over time was confined to vacuum extraction due to signs of fetal distress. CONCLUSIONS: Depending on risk factors, the odds of being delivered by vacuum extraction can vary immensely from one woman to another. Increasing maternal age explains a substantial fraction of the increase in vacuum extraction use since 1992. Whether the increase in vacuum extractions due to fetal distress reflects a true increase in fetal distress during labor remains to be explained.

[Trends in vaginal assisted deliveries in the Moravian-Silesian region between the years 2002-2011]. / Trendy operacních vaginálních porodu v Moravskoslezském regionu v letech 2002-2011.

OBJECTIVE: To analyze trends in vaginal assisted deliveries between 2002-2011 in the Moravian-Silesian region, Czech Republic. DESIGN: Retrospective analysis. SETTING: Obstetric facilities in the Moravian-Silesian region, Czech Republic. METHODS: Analysis of data on vaginal assisted deliveries in the obstetric facilities in the Moravian-Silesian region, Czech Republic, between the years 2002-2011. RESULTS: During the analyzed period the use of vacuum extraction rose from 0.11% to 2.44% of all deliveries and the use of forceps declined from 1.54% to 0.24% of all deliveries. The overall frequency of vaginal assisted deliveries increased from 1.65% to 2.87%. The frequency of caesarean section increased from 16% to 24.5%. CONCLUSION: A fundamental change in the trends of vaginal assisted deliveries occurred in the Moravian-Silesian region between 2002 to 2011. There was a significant reduction in the use of forceps and the rise in the use of vacuum extraction with an overall increase in vaginal assisted deliveries. In comparison with the results of the rest of the Czech Republic, the trends in the Moravian-Silesian region are more pronounced. During the analysed period a significant rise of the cesarean section deliveries occurred.

[Frequency and indication for vacuum extractor delivery].

UNLABELLED: The aim of the study is to analyze the frequency of the vacuum extraction delivery (VE) and the contemporary indications for its use and their frequency. The study included 44,109 births occurred for 14 years period. This clinical trial is prospective and retrospective on 1197 applied VE. The extraction of the fetus was performed by soft cup silicone vacuum extractor type Ameda - Egnell and electric vacuum pump Atmos. We find 4 main indications for VE: acute fetal distress, labor dystokia, arrest of descent and need to avoid voluntary maternal expulsive efforts. RESULTS: The frequency of the VE in the 14 years period was 2.71% with an increasing temps from 2% in the beginning of the period and 5% by its end. The most common indication for VE in 37.08% is acute fetal distress followed by the labor dystokia in 31.42% of the cases. The arrest of descent of the fetal head is indication in 25.31% of the applied VE. The need to avoid voluntary maternal expulsive efforts was indication for VE in 5.48% of the cases. The vacuum stimulation was an indication only in 0.71% of the cases. CONCLUSION: VE is a useful method nowadays in assisted vaginal delivery. VE should not be used in breech presentation. The contemporary indications for VE are: maternal indications (labor dystokia and need to avoid voluntary maternal expulsive efforts) and fetal indications (acute fetal distress and arrest of descent). The acute fetal distress is the leading indication, but with tendency of equalization/decreasing compared to labor dystokia and the arrest of descent. Vacuum stimulation is no more an indication for VE.

[Trends in operative delivery rates]. / Trendy vývoje operacních porodu.

OBJECTIVE: The aim of this study was to identify trends in operative vaginal delivery rates and caesarean sections at Faculty Hospital in Olomouc and comparing with mean results of the Czech Republic. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: Analysis of data drawn from obstetric medical records from 1. 1. 1993 to 31. 12. 2008--rating the frequency, evolutionary trends and associated risk factors. RESULTS: In this time period 26,679 children born, by caesarean section 5,916 (22.2%), ventouse 759 (2.8%) and forceps 526 (2.0%). The frequency of vaginal operations is higher than the average of the Czech Republic and from second half 90s of the 20th century no more increased. For caesarean section, however, is an upward trend (P for trend = 0.035, Cox-Stuart test). The increasing proportion of complex of 4 risk factors on the frequency of caesareans: 1 low birth weight below 2.5 kg (32.2%), 2 multiple pregnancy (18%), 3 caesareans in history (15.5%), 4 mothers over the age of 35 years (11.2%). Cumulative share of all four factors in the total number of abdominal delivery has reached a mean of 52.91% (95% CI 49.58-56.24), median = 53.75 (97.9% CI 48.64-57.32). CONCLUSION: Analysis of the development of operational termination of pregnancy confirms the significantly higher frequency of operational interventions in Olomouc compared to an average of the Czech Republic. Changes in risk profile of patients (often referred to the demographic factors) is not enough to explain the causes of the rising frequency of caesareans. The increase of invasive obstetrics undoubtedly contributes to changes in obstetric practice.

Novos aspectos da vácuo-extração fetal / New aspects of vaccum-extracted deliveries

Apresentamos um dispositivo descartável de manejo simples (Mityvac - Prism Healthcare, San Antonio, Texas) que, embora pouco difundido, já está disponível em alguns hospitais brasileiros e é devidamente licenciado pela Agência Nacional de Vigilância Sanitária (ANVISA). Sua aceitação na Inglaterra e Estados Unidos tem sido grande nos últimos 10 anos. Os principais tempos e cuidados no manuseio do equipamento são expostos

Is vacuum extraction still known, taught and practiced? A worldwide KAP survey.

OBJECTIVE: Is vacuum extraction-the method of first choice for assisting vaginal delivery in case of prolonged labor-losing ground in the developing world? And if it is, why? The paper tries to answer these disturbing questions, and examine their consequences. METHODS: A rapid Knowledge-Attitude-Practice (KAP) survey was conducted during 2003-2004 on the question of assisted vaginal delivery (AVD) by the use of the vacuum extractor. Public health specialists and obstetricians from 121 developing countries were consulted about their knowledge of the method in their country, its reputation (i.e. their attitude) and its use (practice). RESULTS: Overall 48% of the respondent countries have confirmed knowledge, positive attitude, teaching and countrywide use of the method, while 37% said the method is known and used by only a limited number of specialists who do not teach it, and 15% admitted no knowledge and therefore no use. CONCLUSION: Given the evidence-based international recognition of the benefits of vacuum extraction (if practiced correctly and for appropriate indications), it is unjust to deprive women with prolonged labor (and their fetuses) of a simple intervention that can contribute to reducing life threatening complications. This unsophisticated worldwide survey, while not providing in-depth explanations, calls for rehabilitation of vacuum extraction in countries where it is disappearing and surgical extraction is not yet readily accessible to all women with prolonged labor.

Use of the vacuum extractor by midwives--what has changed in the last decade?

This article provides an update on use of vacuum extraction by certified nurse-midwives (CNMs) and certified midwives (CMs). Research findings from the last decade relevant to the training and use of vacuum extractors are reviewed along with professional guidelines and legal implications.

Ventosa obstétrica / Vacuum extractor

La ventosa obstétrica es un instrumento que se basa en la aplicación de una cazoleta sobre la presentación fetal, se fija a esta mediante la aplicación de presión negativa y permite realizar tracción sobre ella para favorecer los mecanismos del parto. En este artículo se repasan las características técnicas de este instrumento, su técnica de aplicación y las complicaciones neonatales asociadas a su uso

Obstetric vacuum extraction is based on the application of a cup to the fetal head which is fixed by negative pressure allowing us to make traction to the fetal presentation favouring delivery mechanisms. In this article we review the technical characteristics of this instrument, technics of application and neonatal complications associated with its use

Trends in the rate of shoulder dystocia over two decades.

OBJECTIVE: To describe the trend in the rate of shoulder dystocia over twenty-four years and identify the risk factors related to the occurrence of dystocia. METHODS: Data was obtained from Maryland State regarding all vaginal deliveries that occurred during six different time periods at five-year intervals since 1979. Trends in the rate of shoulder dystocia, episiotomy, forceps and vacuum delivery were examined. RESULTS: There were a total of 277 974 vaginal deliveries. The overall rate of shoulder dystocia was 1.29% (n = 3590). Induction of labor (adjusted OR 1.2, 1.1-1.3), presence of diabetes (gestational (OR 1.9, 1.7-2.3) or pre-gestational (OR 3.8, 2.7-5.4)), fetal macrosomia (OR 5.1, 4.1-6.3) use of episiotomy (OR 1.6, 1.5-1.8), forceps (OR 1.3, 1.0-1.8) or vacuum (OR 2.3, 2.0-3.9) at delivery were associated with a higher rate of shoulder dystocia. TREND: There was an increase in the rate of shoulder dystocia from 0.2% in 1979 to 2.11% in 2003. In addition there was a drop in the overall episiotomy rate from 73.67% to 23.94% and increase in the use of vacuum from 0.1% to 8.36%. CONCLUSION: The rate of shoulder dystocia has increased by 10 fold during the study period. The use of episiotomy either at spontaneous delivery or instrumental delivery does not appear to decrease the occurrence of shoulder dystocia.

Utilización de vacuum extractor de copa blanda en la atención de partos vaginales / Vacuum extractor with a soft cup is used in vaginal birth deliveries

En Chile, el parto vaginal instrumentalizado está reducido al uso de fórceps y espátulas de Thierry. La tendencia mundial está dirigida al uso de vacuum extractor de copa blanda. El vacuum extractor presenta múltiples ventajas en comparación con el fórceps, tales como requerimientos analgésicos menores, técnica de fácil aprendizaje y menor incidencia de traumatismo neonatal. Presentamos nuestra experiencia con el uso de vacuum extractor de copa blanda, en casos de expulsivo detenido y sufrimiento fetal, como alternativa al fórceps. Se utilizó el vacuum en 3 pacientes, sin traumatismo materno y neonatal.

Controversies in the use of the vacuum extractor.

Operative pelvic delivery is an important component of obstetrical care. Vacuum extraction assumes a prominent role, and when appropriately performed, has been proven safe and effective. However, controversies continue to exist. Historical background and review of the latest literature are presented to delineate these issues and promote consensus and direct research to continue to provide the safest means of delivery for the mother and baby.

Operative delivery during labour: trends and predictive factors.

Monitoring operative delivery trends provides the opportunity to consider whether changes are in a direction that will achieve the best outcomes for mothers and their infants. The aims of this study were to identify trends in and predictors of operative delivery (forceps, vacuum or caesarean) among women who have labour; and to determine trends in the operative methods used. The study was based on 616 303 live, singleton, term births delivered between 1990 and 1997 in New South Wales, Australia. There was no change in the annual percentage of women who experienced labour and 20% had an operative birth during labour. The vacuum to forceps ratio declined from 1 : 6 in 1990 to 1 : 1 in 1997. Among women with labour, caesareans increased from 6.4% to 7.8%. For primiparae, the factors predictive of operative delivery (epidural analgesia, age > 34 years, induced or augmented labour and private care) did not change over time. A predictive model for multiparae did not have adequate fit, indicating the importance of data on prior birth history. Studies of trends in operative deliveries are most useful and consistent with decision making when interventions before the onset of labour and during labour are analysed separately. Furthermore, the vacuum:forceps ratio provides a useful tool for comparative analyses.

[Trends in the frequency of obstetrical operations and perinatal mortality in the Czech Republic in comparison with other countries]. / Vývoj frekvence porodnických operací a perinatální úmrtnosti v Ceské republice v mezinárodním srovnání.

In an international epidemiological survey during a 10-year period the increase of obstetric operations was investigated in 11 countries with advanced perinatal care. Major differences were found as regards the frequency of Caesarean sections as well as vaginal operations (forceps and vacuum extraction). The mean effectiveness of the increase in the frequency of Caesarean sections on the reduction (evaluated by the mille drop of perinatal mortality rate is reduced when the frequency of Caesarean section) exceeds about 10%. Of all investigated countries only the Netherlands and the Czech Republic achieve a low perinatal mortality, while the frequency of Caesarean sections is low. The author discusses the reasons for the revealed differences between different countries.

Vaginal operative deliveries in Italy.

OBJECTIVE: To analyze the trends in vaginal operative deliveries in Italy. DESIGN: Analysis of information on all deliveries after the 28th week of gestation, routinely collected by the Italian Central Institute of Statistics using a standard form. SETTING: National data on all Italian deliveries in the period 1981-85. SUBJECTS: All deliveries occurred in Italy in the period. RESULTS: Forceps and vacuum delivery were reported in 1981 respectively in 0.9 and 2.1/100 deliveries. Similar percentages were observed during the whole considered quinquennium for vacuum extraction, but the forceps delivery rate decreased to 0.6/100 in 1985. Nulliparous women more frequently had an operative vaginal delivery: the rates of forceps and vacuum deliveries were respectively 1.1 and 3.7/100 in nulliparae and 0.3 and 1.0 in women reporting one or more previous births. There was a direct relationship between vacuum delivery rate and birth weight: vacuum deliveries were reported for respectively 0.9 and 2.3/100 infants weighing less than 2500 g and > or = 2500 g. Likewise, vaginal operative deliveries were more frequent in term or post-term births, and vacuum deliveries among singleton births than multiple ones (2.3 vs 1.7/100 deliveries). CONCLUSIONS: Operative vaginal delivery rates in Italy in the mid 1980's were lower than in most developed countries. The reasons for forceps and vacuum extraction were similar to other developed countries with regard to obstetric determinants, but some differences emerged for socio-demographic factors.

Trends in obstetric operative procedures, 1980 to 1987.

OBJECTIVES: Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. METHODS: We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. RESULTS: The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. CONCLUSIONS: As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures.