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Vacuum extraction failure is associated with a large head circumference.

Doron Kabiri1, Michal Lipschuetz1,2, Sarah M Cohen1

  • 1a Department of Obstetrics and Gynecology , Hadassah Hebrew University Medical Center , Jerusalem , Israel.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|April 11, 2018
PubMed
Summary

Large fetal head circumference significantly increases the risk of vacuum extraction failure. This finding highlights head size as a critical factor in operative vaginal delivery success, independent of birth weight.

Keywords:
Birth-weightFHChead circumferenceinstrumental deliveryvacuum extraction

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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Medicine
  • Neonatal Outcomes

Background:

  • Operative vaginal delivery, including vacuum extraction, is a common intervention in modern obstetrics.
  • Vacuum extraction success rates can be influenced by various maternal and fetal factors.
  • Identifying specific risk factors for vacuum extraction failure is crucial for improving obstetric outcomes.

Purpose of the Study:

  • To investigate the association between large fetal head circumference and the risk of vacuum extraction failure.
  • To compare the risk of vacuum extraction failure in neonates with large head circumference versus those with large birth weight.

Main Methods:

  • Retrospective electronic medical record (EMR)-based study of term singleton live births undergoing attempted vacuum extraction.
  • Classification of cases into four groups based on fetal head circumference and birth weight percentiles (≥90th vs. <90th).
  • Multinomial multivariable regression analysis to determine adjusted odds ratios (aOR) for vacuum extraction failure, controlling for confounders.

Main Results:

  • A total of 3835 vacuum extractions were attempted, with a 5.6% failure rate (215 cases).
  • Large fetal head circumference (≥90th percentile) was significantly associated with increased odds of vacuum extraction failure (aOR = 2.31; 95% CI, 1.7-3.15; p < 0.001).
  • Primiparity, prolonged second stage of labor, and occipito-posterior presentation were also identified as significant risk factors.

Conclusions:

  • Large fetal head circumference is an independent risk factor for vacuum extraction failure.
  • Head circumference, rather than high birth weight, appears to be a more critical determinant of vacuum extraction success.
  • These findings have implications for risk assessment and management during operative vaginal deliveries.