Vacuum-assisted Delivery Research Articles

Sonographic risk assessment for an unplanned operative delivery: a prospective study.

To assess the value of pre-labor maternal and fetal sonographic variables to predict an unplanned operative delivery. In this prospective study, nulliparous women were recruited at 37.0-42.0weeks of gestation. Sonographic measurements included estimated fetal weight, maternal pubic arch angle, and the angle of progression. We performed a descriptive and comparative analysis between two outcome groups: spontaneous vaginal delivery (SVD) and unplanned operative delivery (UOD) (vacuum-assisted, forceps-assisted and cesarean deliveries). Multivariate logistic regression with ROC analysis was used to create discriminatory models for UOD. Among 234 patients in the study group, 175 had a spontaneous vaginal delivery and 59 an unplanned operative delivery. Maternal height and pubic arch angle (PAA) significantly correlated with UOD. Analysis of Maximum Likelihood Estimates revealed a multivariate model for the prediction of UOD, including the parameters of maternal age, maternal height, sonographic PAA, angle of progression (AOP), and estimated fetal weight, with an area under the curve of 0.7118. Sonographic parameters representing maternal pelvic configuration (PAA) and maternal-fetal interface (AOP) improve the prediction ability of pre-labor models for a UOD. These data may aid the obstetrician in the counseling process before delivery.

Association between second stage of labour length and risk of obstetrical anal sphincter injury in nulliparous women: a population-based retrospective cohort study.

Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk. A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries. Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10-1.12). When stratified by mode of delivery, second stage length ≥ 90min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15-1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11-1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage. Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland.

ObjectiveTo examine severe birth‐related injuries in neonates among mothers with different types of diabetes.MethodsRetrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35+0 weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes.ResultsThere were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non‐diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum‐assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies.ConclusionNeonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non‐diabetic women is generally low.

Incidence of retinal hemorrhages in full-term newborn babies in a tertiary care hospital in India

Context: Neonatal retinal hemorrhage (RH) is a condition occurring in newborns within 1 month of birth. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Aims: This study aimed to estimate the incidence of retinal hemorrhages (RHs) in full-term newborn babies in a medical college tertiary care hospital over a period of 1 year and to determine the association between RH and the mode of delivery. Settings and Design: This was a prospective observational study. Subjects and Methods: Screening was done in 469 full-term newborn babies within a week of delivery. Pupils were dilated with 0.4% tropicamide and 2.5% phenylephrine. Retinal evaluation was done with indirect ophthalmoscope and 20D lens. Statistical Analysis Used: Data analysis was done using SPSS software version 21. Chi-square test was used to assess the association between sex of the baby, mode of delivery, birth weight, and RH. P < 0.05 was considered statistically significant. Results: Out of 469 babies screened, 27 had RH on fundus examination. Of the 266 babies who were born spontaneously through vaginal route, 20 babies had RH. Eleven babies were delivered through vacuum-assisted vaginal delivery, of which 5 had RH. Babies weighing >2.5 kg had a higher incidence of RH (6.3%). There was no significant association between sex and RH. Conclusion: The incidence of RH in newborn babies was found to be 5.8%. Incidence of RH was found to be high among vacuum-assisted delivery followed by spontaneous vaginal delivery. Babies weighing >2.5 kg had a higher incidence of RH. By 2 weeks after birth, RH resolved in 96.29% of eyes.

Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital.

There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore. A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed. A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation. The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia.

Objective:In developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above.Methods:Health facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05.Results:Complications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092–0.658), 120–160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114–0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729–9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057–0.339) were associated with complications of instrumental vaginal delivery.Conclusion:Magnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.

A known case of myocardial infarction and its outcome in pregnancy

Acute myocardial infarction (AMI) is rare in women of child- bearing age during pregnancy. Its prevalence is 1/10,000–30,000. A 32-year-old primigravida, with a history of acute MI 1 year ago, presented to us with regular antenatal checkups and was followed up to term. She was asymptomatic throughout her pregnancy. Electrocardiogram, two-dimensional echocardiogram, cardiology opinion, and preanesthetic evaluation were done. Under strict maternal and fetal monitoring, the mother went into spontaneous labor and delivered by vacuum-assisted vaginal delivery. Both the mother and the baby were stable and healthy. She was asymptomatic in her postpartum period and was discharged on postnatal day 8.

Vacuum assisted delivery outcomes. Does advanced maternal age matter?

This study evaluated whether advanced maternal age during vacuum-assisted delivery (VAD) leads to a higher rate of adverse maternal and neonatal outcomes. This retrospective cohort study included all nulliparous women who underwent a singleton, VAD in our institution, from 2014 through 2019. The women were grouped according to maternal age ≥ 35 in the study group and < 35 in the control group. Power analysis calculation determined that a sample size of at least 225 women in each group was sufficient to detect significant differences between groups in the rate of third- and fourth-degree perineal tears and umbilical cord pH < 7.15. primary maternal outcomes were third- and fourth-degree perineal tears. primary neonatal outcomes were umbilical cord pH < 7.15. Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between the two groups. During the study period, 13,967 nulliparous women delivered in our institution, including 8,810 (63.1%) spontaneous vaginal deliveries, 2,432 (17.4%) instrumental deliveries and 2,725 (19.5%) cesarean sections. The rate of operative vaginal delivery was higher in the advanced maternal age group. Among the vaginal deliveries, 10,116 (90%) were to women < 35, with 2,067 (20.5%) successful vacuum-assisted delivery VAD, and 1,126 (10%) were to women ≥35 years, with 348 (30.9%) successful VAD. There were no significant differences in the rates of third and fourth-grade perineal lacerations or lower cord pH between the study groups. Although there was no difference in the indications for the procedure between the groups, advanced maternal age was associated with a higher head station during the pre-procedure assessment (p=0.002). Vacuum-assisted delivery is not associated with a higher risk for adverse maternal or neonatal outcomes among women with advanced maternal age.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Vacuum-assisted delivery complications rate based on ultrasound-estimated fetal weight

Studies evaluating complications of operative vaginal deliveries based on ultrasound estimated fetal weight (EFW) are sparse. This study investigated the association between high ultrasound EFW (≥3700 g) and adverse maternal and neonatal outcomes during vacuum-assisted delivery (VAD).

Neurological neonatal birth injuries caused by vacuum-assisted delivery

Many complications can occur to a new-born during a vacuum-assisted delivery. Vacuum-assisted deliveries are considered to be safe and there seems to be insufficient evidence of long-term neurodevelopmental effects. There has always been a debate among clinicians about the risk of major neonatal injury using vacuum extraction. The major complications presented in this article are: intracranial haemorrhage, subgaleal haemorrhage, seizures, cerebral infarction, hypoxic-ischemic encephalopathy and permanent brachial plexus injury. We included several retrospective studies discussing these major complications. The incidence of vacuum related birth injuries was proven to be higher than the incidence of spontaneous birth injuries; however, the overall incidence was low.

Trends in Operative Delivery in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5 years' Retrospective Review.

Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristics. A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables. The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July 2011 to 9.9% in June 2016, while it shows a noticeable rise in cesarean section rate 25.4% to 33.8%. The trend in the use of vacuum has shown a sharp decrease from 58% in the 1st year to 10.5% in the fifth year of the study period. There is a rise in the use of forceps from 42% of all operative vaginal delivery in the first year to 89.5% in the fifth year. This study shows that the rate of operative vaginal delivery has declined. The use of vacuum-assisted delivery has especially decreased compared to that of forceps-assisted delivery.

Episiotomy or not? Midwives' experiences of recruiting to a randomized controlled trial during pregnancy and labor – A qualitative study

ObjectiveThe performance of randomized controlled trials (RCTs) is dependent on recruitment. Recruiting women to RCTs regarding interventions during childbirth may be difficult due to time constraints and their vulnerable situation. Midwives play a major role in such recruitment. Few studies have investigated the views and experiences of recruiters. The aim of this study was to describe midwives’ experiences of recruiting pregnant women regarding an RCT of lateral episiotomy or no episiotomy in vacuum-assisted delivery. MethodsIn this qualitative study, 19 midwives were interviewed regarding their experiences. The midwives worked at antenatal health care centers or labor wards. The transcribed interviews were analyzed using content analysis. ResultsFour categories appeared during the analysis, including “experiences and perceptions of providing trial information” and “the right timing in providing trial information,” which varied among the midwives. Midwives’ perceptions of how the women provided consent or declined participation, and the women’s views and questions about the randomization and intervention, were summarized as “experiences of how the trial information was received by the women.” In the final category, “perceived trial apprehensions and concerns,” some midwives described ethical concerns related to the intervention and financial compensation to the staff involved. ConclusionsMidwives as recruiters would benefit from education and training in incorporating basic and advanced details of trial design and research methods, as well as training and support in recruitment. Awareness and management of the variation among potential recruiters is important when designing and performing an RCT.

Resident and program director confidence in resident preparedness for operative vaginal deliveries in Obstetrics and Gynecology Training Programs in the United States

Operative vaginal delivery is used to expedite a safe vaginal delivery in the second stage of labor and is considered an essential part of residency training in obstetrics and gynecology. To assess the self-reported readiness of obstetrics and gynecology residents in the United States to perform vacuum-assisted vaginal delivery and forceps-assisted vaginal delivery compared with the perceptions of program directors. The Council on Resident Education in Obstetrics and Gynecology surveyed the residents in all US training programs about their readiness to perform forceps-assisted and vacuum-assisted deliveries. The program directors were simultaneously surveyed about the readiness of their cohort to perform operative deliveries with and without attending oversight. The primary outcome of the survey was the residents' self-reported confidence in their ability to autonomously and independently perform operative deliveries. Α total of 5084 out of 5514 (92.9%) resident physicians and 241 out of the 292 (83%) residency program directors completed the survey. Eighty-seven percent (95% confidence interval, 84.9-88.9) of the graduating residents reported feeling that they could autonomously perform a vacuum-assisted vaginal delivery, compared with 49.5% (95% confidence interval, 46.6-52.4) for forceps-assisted vaginal delivery (P<.01). Similarly, whereas 95.9% (95% confidence interval, 94.6-97.0) of the residents felt that they could confidently perform an emergency vacuum-assisted vaginal delivery, only 42.3% (95% confidence interval, 39.4-45.2) felt confident performing an emergency forceps-assisted vaginal delivery (P<.01). The residency program directors significantly overestimated their residents' confidence in independently performing an emergency forceps-assisted vaginal delivery or vacuum-assisted vaginal delivery than the residents themselves (54% [95% confidence interval, 47.1-60.5] vs 24% [95% confidence interval, 22.5-24.9] and 98.6% [95% confidence interval, 97.0-100] vs 71.9 [95% confidence interval, 70.6-73.2] respectively P<.01). Trainees in military-based residency programs and those interested in pursuing a career as generalists or maternal-fetal medicine specialists reported significantly higher preparedness to perform a forceps-assisted vaginal delivery. Graduating obstetrics and gynecology residents report feeling less prepared to independently perform a forceps-assisted vaginal delivery than a vacuum-assisted vaginal delivery. The program directors had more confidence in the ability of their residents to perform an operative vaginal delivery than the residents themselves.

Women\u2019s experiences of receiving information about and consenting or declining to participate in a randomized controlled trial involving episiotomy in vacuum-assisted delivery: a qualitative study

BackgroundInformation about and invitation to participate in a clinical trial involving an intervention during childbirth may cause fear or worry in pregnant women. The aim of this study was to describe nulliparous women’s experiences of receiving an invitation to participate in a randomized controlled trial (RCT) of lateral episiotomy versus no episiotomy in vacuum-assisted delivery (EVA trial).MethodsThis qualitative study was nested in the ongoing EVA trial. Data were collected through semistructured telephone interviews with 23 women regarding their experiences of the information and invitation to participate in the EVA trial. Interviews were audio-recorded and transcribed verbatim. A qualitative content analysis was used to analyse the interview contents.ResultsThree main experience categories were identified among the participants. “Timing of trial information and understanding” revealed that women preferred to obtain information about the trial early on during pregnancy. “Reasons to consent to or decline participation in the trial” encompassed a variety of reasons for women to consent, such as goodwill for science or personal benefits, or to decline, such as not wanting to be randomized or fear of increased risk of having a vacuum-assisted delivery. “Thoughts evoked regarding childbirth” were diverse, ranging from not being affected at all to having increased anxiety.ConclusionsThe women’s experience of receiving an invitation to participate in an RCT of episiotomy in vacuum-assisted delivery varied widely, from immediately giving consent without further worries to increased anxiety or declining participation. Early and personal information with time for reflection was considered most satisfactory.Trial registrationClinicalTrials.govNCT02643108. Registered on December 28, 2015. The Lateral Episiotomy or Not in Vacuum Assisted Delivery in Non-parous Women (EVA) trial was registered at www.clinicaltrials.gov.

Vacuum-assisted vaginal deliveries among parturients with congenital uterine anomalies; risk factors and outcomes

ObjectiveTo evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery (VAVD) in a subset of parturients with congenital uterine anomalies. Study DesignA retrospective database study was conducted at a single tertiary center between 2005 and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries were enrolled, whereas parturients with failed VAVD, didelphic uterus, and delivery after intrauterine fetal death were excluded. Various maternal and neonatal outcomes were compared between parturients who achieved spontaneous vaginal delivery (SVD) and those who delivered via VAVD. The maternal composite outcome was calculated for each group and included one or more of the following: post-partum hemorrhage, hemoglobin drop ≥ 4 gr/dL, blood transfusions, retained placental products, and obstetric anal sphincter injuries. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. ResultsAfter the application of the exclusion criteria, 332 parturients were found eligible. Of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous parturients and epidural analgesia users. Parturients with VAVD had higher rates of third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%, p < 0.01). After controlling for potential confounders, the maternal composite outcome was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10–4.60). The neonatal results were overall comparable, except for scalp trauma and Erb’s palsy/clavicular fracture, which were more prevalent in the VAVD group. ConclusionIn a special population of parturients with congenital uterine anomalies, VAVD was found to be associated with significantly higher rates of adverse maternal outcomes and perinatal birth trauma. These findings should be presented to parturients during consultations about modes of delivery.

Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit.

Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery. This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1month postpartum-faecal incontinence andstress, urgency and mixed urinary incontinence-as well as pelvic floor muscle strength scores based on the modified Oxford scale. Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p= 0.70, difference in prevalence [forceps - vacuum]: 5.4%, 95% CI -0.25, +0.15), frequency (p= 0.40) and amount (p= 0.48) of urine leakage or mean muscle strength scores (p= 0.89). In our maternity unit, we observed that type of operative vaginaldelivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.

Delayed infant subaponeurotic (subgaleal) fluid collection

A 13-week-old male infant was referred to a pediatric neurosurgery clinic for evaluation of an occipitoparietal scalp mass without any trauma. He was born by vacuum-assisted delivery at 40 weeks’ gestation and weighed 3330 g at birth. No scalp swelling or bruising was observed in the immediate postnatal period. At 7 weeks, the parents noted a mobile and fluctuant scalp swelling, which increased and then stabilized. It was soft, nontender, and not limited by suture lines. No signs of bruising or trauma were noted (Fig. 1).

Adverse outcomes in vacuum-assisted delivery after detachment of non-metal cup: a retrospective cohort study.

To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments. This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014-August 2019. Failed vacuum deliveries were excluded. Primary outcomes were defined as subgaleal hematoma (SGH) and cord blood pH < 7.15. Secondary outcome included other neonatal complications and adverse maternal outcomes. Outcomes were compared between vacuum-assisted deliveries with and without cup detachment during the procedure. A total of 3246 women had successful VAD and met the inclusion criteria. During the procedure, the cup detached at least once in 665 (20.5%) deliveries and did not detach in 2581 (79.5%). The cup detachment group experienced higher rates of SGH (8.9% vs. 3.5%, p = 0.001) and cord blood pH < 7.15 (9.8% vs. 7.1%, p = 0.03). There were also more neonatal intensive care unit admissions (NICU) (4.4% vs. 2.7%, p = 0.03) and more fetuses with occiput posterior position (70.8% vs. 79.4%, p = 0.001), the vacuum duration was slightly longer (6 ± 3.7 vs. 5 ± 2.9min) and more neonates had birth weights > 3700g (14.1% vs, 10.3%, p = 0.006). Interestingly, there were more males in that group (60.6 vs. 54.6, p = 0.005). All these factors remained significant after controlling for potential confounders. Vacuum cup detachment has several predictive characteristics and is associated with adverse neonatal outcomes that should be incorporated into decisions made during the procedure.

Comparison of a practice-based versus theory-based training program for conducting vacuum-assisted deliveries: a randomized-controlled trial

PurposeVacuum-assisted deliveries (VAD) are complex procedures that require training and experience to be performed proficiently. We aimed to evaluate if a more resource intensive practice-based training program for conducting VAD is more efficient compared to a purely theory-based training program, with respect to immediate training effects and persistence of skills 4–8 weeks after the initial training.MethodsIn this randomized-controlled study conducted in maternity staff, participants performed a simulated low-cavity non-rotational vacuum delivery before (baseline test) and immediately after the training (first post-training test) as well as 4–8 weeks thereafter (second post-training test). The study’s primary endpoint was to compare training effectiveness between the two study groups using a validated objective structured assessment of technical skills (OSATS) rating scale.ResultsSixty-two participants were randomized to either the theory-based group (n = 31) or the practice-based group (n = 31). Total global and specific OSATS scores, as well as distance of cup application to the flexion point improved significantly from baseline test to the first post-training test in both groups (pall < 0.007). Skill deterioration after 4–8 weeks was only found in the theory-based group, whereas skills remained stable in the practice-based group.ConclusionA practice-based training program for conducting VAD results in comparable immediate improvement of skills compared to a theory-based training program, but the retention of skills 4–8 weeks after training is superior in a practice-based program. Future studies need to evaluate, whether VAD simulation training improves maternal and neonatal outcome after VAD.

Raccoon eyes in a newborn

Introduction: Periorbital ecchymoses or “raccoon eyes” in the neonate/infant may be due to basal skull fractures or neuroblastoma. Case Report: A term male baby born by vacuum-assisted delivery developed a medium size subgaleal hematoma on the first day of life (DOL). On the third DOL, bilateral periorbital ecchymosis (raccoon eyes) developed. The cerebral ultrasound, hematologic and coagulation studies were normal. The raccoon eyes were interpreted as an extension of the subgaleal hematoma to the orbital ridges. At DOL 38, he was thriving and the raccoon eyes were resolved. Discussion: “Raccoon eyes” may result from a subgaleal hematoma without fracture caused by birth trauma.