Open AccessAssociation of traction force and adverse neonatal outcome in vacuum‐assisted vaginal delivery: A prospective cohort study
Author(s) -
Pettersson Kristina A.,
Westgren Magnus,
Blennow Mats,
Ajne Gunilla
Publication year - 2020
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13952
Subject(s) - medicine , neonatal intensive care unit , prospective cohort study , vaginal delivery , odds ratio , cohort study , gestational age , confidence interval , relative risk , intensive care , traction (geology) , apgar score , obstetrics , pregnancy , pediatrics , surgery , intensive care medicine , biology , genetics , geology , geomorphology
Traction force is a possible risk factor for adverse neonatal outcome in vacuum extraction delivery, but the knowledge is scarce and further investigation is needed. Our hypothesis was that high‐level traction force increases the risk of admission to the neonatal intensive care unit. Material and methods The study was a hospital‐based prospective cohort study on low‐ and mid‐vacuum extractions at the labor and delivery ward, Karolinska University Hospital, Huddinge, Sweden. Traction forces were measured in 331 women. An electronical handle was used to measure and register traction force. The main exposure variable was high‐level traction force (≥75th percentile) during the first three pulls and the primary outcome was admission to the neonatal intensive care unit. Logistic regression was used to estimate the adjusted risk. Results Among the exposed, 14/84 (16.7%) were admitted to neonatal intensive care, and among the unexposed 10/247 (4%). The crude odds ratio (OR) of admission to the neonatal intensive care unit when exposed to high‐level traction force was 4.7, and the adjusted (birthweight, gestational length, cup detachment, number of pulls, duration, duration >15 minutes, mid‐cavity fetal head station, failed extraction, indication and parity) OR was 2.85 (95% confidence interval [CI] 1.09‐7.48). No significant effect was seen in Apgar scores <7 at 5 minutes or pH <7.1. Conclusions High‐level traction force may be a risk factor for neonatal complications. Although these results do not mandate any alterations in clinical guidelines, perioperative feedback on traction force may be useful to alert the obstetrician to a timely conversion to cesarean section. To study plausible traction force specific outcomes such as head traumas, a larger sample size is required.