Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter?

PURPOSE: To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome.

METHODS: Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007-2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders.

RESULT: Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04-1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26-4.67) and asphyxia (aOR 1.81 95% CI 1.35-2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38-2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity.

CONCLUSION: The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5' Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.