Head position and vacuum-assisted delivery using the Kiwi Omnicup

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Surgical Outcomes

Background:

• Fetal head presentation is crucial during labor and delivery.
• Vacuum-assisted delivery (VAD) is a common intervention for prolonged or obstructed labor.
• Understanding factors influencing VAD outcomes is essential for improving maternal and neonatal safety.

Purpose of the Study:

• To investigate the association between fetal head position at prevacuum assessment and adverse outcomes in vacuum-assisted deliveries.
• To identify specific risks associated with different fetal head presentations during VAD.

Main Methods:

• Retrospective cohort study of 1960 vacuum-assisted deliveries using the Kiwi Omnicup.
• Outcomes compared between occiput posterior (OP) and occiput anterior (OA) fetal head positions.
• Primary outcomes included severe perineal tears, low umbilical cord pH, and subgaleal hematoma (SGH).

Main Results:

• Occiput posterior (OP) position was linked to higher rates of epidural analgesia, cup detachments, and longer procedure times.
• OP position showed increased associations with low umbilical cord pH (<7.1), NICU admissions, SGH, and high-degree perineal tears.
• After adjustment, SGH and high-grade perineal tears remained significantly associated with OP position.

Conclusions:

• Occiput posterior (OP) fetal head presentation is an independent risk factor for anal sphincter injury and subgaleal hematoma (SGH) during vacuum-assisted delivery.
• These findings highlight the importance of considering fetal head position in the management of vacuum-assisted deliveries.
• Further research may explore strategies to mitigate risks associated with OP presentation during VAD.