370 The risk of failed operative delivery - impact on maternal and neonatal adverse outcome

Abstract

Operative delivery (OP) is associated with adverse perinatal outcome, however, cesarean delivery (CD), especially at second stage of labor has also an impact on adverse outcome. We aimed to compare perinatal outcome between delivery routes at second stage of labor - CD, successful OP or CD following failed OP. A retrospective cohort study of all live, singleton deliveries in one medical center (2018-2019). Preterm deliveries <34 weeks, spontaneous vaginal deliveries and any CD before second stage of labor were excluded. Maternal demographics and perinatal outcomes were compared between 3 groups: CD, successful OP and CD after failed OP. Primary outcome was defined as neonatal composite outcome (including: pH<7.1, 5-minute Apgar score<8 and NICU admission). Secondary outcome included maternal composite outcome (including: DIC, relaparotomy, hysterectomy, readmission and ICU admission) and other separate adverse outcomes. Multivariable logistic regression analysis was used to adjust for potential confounders. P value< 0.05 was considered significant. Overall, 779 deliveries met inclusion criteria. Of them, 628 (80.6%) had successful OP ,128 (16.4%) had second stage CD, and 23 (2.9%) had CD after failed OP. Women that underwent CD after failed OP had lower BMI compared to OP and CD (26.4 vs 28 vs 30.6, Kg/m2 p=0.001). Rates of neonatal composite outcome, low PH (<7.1) and NICU admission were higher following CD after failed OP (p<0.05 for all). There was no difference in maternal outcome between groups, except for higher rates of readmission for the group who had CD (1.1% vs 7.8% vs 4.3%, p<0.001). After adjusting for potential confounders, neonatal composite outcome remained significantly worse for the group who had CD following failed OP (aOR 2.38, 95% CI 1.18-4.7, p=0.015). When intervention during second stage of labor is warranted, failed OP seems to be associated with less favorable neonatal outcome compared to CD or successful OP. Nevertheless, method of intervention chosen has minor impact on maternal outcome.View Large Image Figure ViewerDownload Hi-res image Download (PPT)