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Vacuum-Associated Neonatal Injury by Mode of Delivery [153]

BACKGROUND: The incidence of cesarean delivery is increasing and additionally the incidence of vacuum-assisted cesarean delivery is also increasing. There has been a lack of research on the risk for neonatal injury when using a vacuum assist device at the time of cesarean delivery. We investigated the risk for vacuum-associated neonatal injuries by the mode of delivery. METHODS: This study was a retrospective cohort study comparing vacuum-assisted vaginal deliveries and vacuum-assisted cesarean deliveries using data from July 1, 2006, to November 31, 2013, at The Hospital of Central Connecticut. Participants were identified using billing codes for vacuum assist devices. The primary outcome was odds of vacuum-associated neonatal injury when comparing use of the vacuum assist device either vaginally or at the time of cesarean delivery. Secondary outcomes included assessment of predictors for maternal complications when vacuum assist devices were used in both the vaginal and cesarean delivery groups. RESULTS: A total of 364 patients had vacuum-assisted delivery, 143 (39.3%) vaginal delivery, and 221 (60.7%) cesarean delivery. Vacuum-associated neonatal injuries alone were higher in the vaginal delivery group after controlling for interaction between predictors (odds ratio 2.2, 95% confidence interval 1.14–4.36, P=.05). There were no significant predictors of maternal complications in either the vaginal or cesarean delivery groups. Additionally, an increased incidence of vacuum assisted cesarean deliveries was found (2.9–9.9%). CONCLUSION: Vacuum-assisted vaginal delivery is associated with significantly more vacuum-associated neonatal injury than vacuum-assisted cesarean delivery. However, with the increase in the cesarean delivery rate, this risk should not be minimized. Also, the use of the vacuum alone is more predictive of adverse maternal and neonatal outcomes when compared with all other predictors.