[Failure of vacuum extractions: risk factors, maternal and fetal issues]

Abstract

Objectives: Determine cases which are at risk of vacuum extraction failure as well as maternal and foetal issues depending on the delivery outcome.

Material and methods: It was a retrospective study comparing 147 vacuum failures, from January 2002 to December 2010, with a control group randomly composed of 526 successful vacuum extractions. The outcomes were high risk situations of vacuum failure, maternal and neonatal morbidity depending on the delivery method (caesarean section or other instrumental extraction).

Results: The global vacuum failure rate was 3.3 %. During labour, we identified several situations at risk of vacuum extraction failure: cephalhematomas prior to extraction (P<0.001), deflexion attitude (P<0.001), posterior variety (P<0.001), entering above the inlet strait (P<0.001), occiput posterior delivery (P<0.001), fœtal weight greater than 3500g (P=0.023). Neonatals consequency were more Apgar score below 7 at five minutes life (P=0.007), fœtal acidosis (pH<7,20) (P=0.032), neonatal resuscitation (P<0.001), and craniofacial damages (P<0.001).

Conclusion: Many dystocic situations occurring during labour require intense care when practicing vacuum extraction since they more frequently result in failure. In case of vacuum extraction failure, immediate adaptation to extra-uterine life seems to be more difficult for new-born babies.

Keywords: Extraction instrumentale; Fœtal morbidity; Instrumental extraction; Maternal morbidity; Morbidité fœtale; Morbidité maternelle; Pose séquentielle d’instruments; Sequential use of instruments; Vacuum; Ventouse.

Copyright © 2013 Elsevier Masson SAS. All rights reserved.