Abstract
Objective
The increased risk of neonatal morbidity in relation to operative vaginal delivery is well established, with a growing awareness to adverse neurodevelopmental outcomes of the offspring. We aimed to investigate the effect of failed vacuum procedures on the long-term pediatric neurological morbidity.
Study Design
We performed a population based cohort study to assess the risk of long-term neurological morbidity (up to the age of 18 years) including children born following successful operative vaginal delivery vs. a failed procedure leading to an emergent cesarean delivery. We included all vacuum deliveries that occurred between the years 1991 and 2013 at our tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative pediatric neurological morbidity, and a Cox proportional hazards model was used to control for confounders. A pre-defined set of ICD-9 codes was used to assess neurological morbidity during hospitalizations across the study period.
Results
A total of 7978 neonates underwent a vacuum delivery attempt across the study period, meeting the inclusion criteria, and were included in the analysis. The procedure resulted in a successful delivery in 7733 cases (96.9%), while it failed in 245 (3.1%). Total neurological morbidity was comparable between the groups (3.0% vs. 3.3%, p=0.81, selected morbidities shown in Table). The Kaplan-Meier survival curve exhibited no difference in cumulative incidence of total neurological morbidity (Log rank p=0.97; Figure). In the Cox regression model, a failed vacuum delivery was not associated with increased long-term neurological morbidity compared to a successful procedure, after adjusting for confounding factors such as maternal age, preterm delivery, birthweight, gestational diabetes and preeclampsia (aHR 1.04, 95% CI 0.5-2.1, p=0.9).
Conclusion
A failed vacuum delivery is not associated with increased pediatric neurological morbidity of the offspring studied up to 18 years of age.
The increased risk of neonatal morbidity in relation to operative vaginal delivery is well established, with a growing awareness to adverse neurodevelopmental outcomes of the offspring. We aimed to investigate the effect of failed vacuum procedures on the long-term pediatric neurological morbidity.
Study Design
We performed a population based cohort study to assess the risk of long-term neurological morbidity (up to the age of 18 years) including children born following successful operative vaginal delivery vs. a failed procedure leading to an emergent cesarean delivery. We included all vacuum deliveries that occurred between the years 1991 and 2013 at our tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative pediatric neurological morbidity, and a Cox proportional hazards model was used to control for confounders. A pre-defined set of ICD-9 codes was used to assess neurological morbidity during hospitalizations across the study period.
Results
A total of 7978 neonates underwent a vacuum delivery attempt across the study period, meeting the inclusion criteria, and were included in the analysis. The procedure resulted in a successful delivery in 7733 cases (96.9%), while it failed in 245 (3.1%). Total neurological morbidity was comparable between the groups (3.0% vs. 3.3%, p=0.81, selected morbidities shown in Table). The Kaplan-Meier survival curve exhibited no difference in cumulative incidence of total neurological morbidity (Log rank p=0.97; Figure). In the Cox regression model, a failed vacuum delivery was not associated with increased long-term neurological morbidity compared to a successful procedure, after adjusting for confounding factors such as maternal age, preterm delivery, birthweight, gestational diabetes and preeclampsia (aHR 1.04, 95% CI 0.5-2.1, p=0.9).
Conclusion
A failed vacuum delivery is not associated with increased pediatric neurological morbidity of the offspring studied up to 18 years of age.
| Original language | American English |
|---|---|
| Pages (from-to) | S535-S536 |
| Journal | American Journal of Obstetrics and Gynecology |
| Volume | 216 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2017 |