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Poster Session 3

(779) Clinical Chorioamnionitis is a Major Risk Factor for Failed Vacuum-Assisted Deliveries

Friday, January 31, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Itamar Gilboa, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

    • Coauthor(s)

  • Daniel Gabbai, MD, MPH

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

  • AL

    Anat Lavie, MD

    Tel Aviv Sourasky Medical Center
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • YY

    Yariv Yogev, MD

    Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • Emmanuel Attali, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

Objective:

We aimed to determine the impact of  clinical chorioamnionitis during labor and the risk of failed vacuum-assisted delivery (VAD).

Study Design:

A retrospective cohort study at a single university-affiliated tertiary medical center with approximately 12,000 deliveries annually from 2011-2023. The study group included singleton pregnancies at ≥36 weeks' gestation undergoing a trial of vacuum delivery. The study group, comprising cases of failed vacuum extraction (defined by extraction duration over 20 minutes, more than two cup detachments, or the operator's decision to switch to urgent cesarean delivery), and the control group, consisting of successful vacuum extractions. Clinical chorioamnionitis was diagnosed with an intrapartum fever of ≥38°C and the presence of either a white blood cell count ≥15,000 or documentation of a commonly used broad-spectrum antibiotic regimen for clinical chorioamnionitis.

Results:

 

1. Vacuum extraction was attempted in 9,402 out of 111,878 vaginal deliveries (8.4%).
2. The rate of failed VAD was 197/9402 deliveries (2.1%).
3. Multivariate logistic regression analysis identified clinical chorioamnionitis as the major independent risk factor for failed VAD (OR = 3.65, 95% CI 2.3-5.8, p < 0.001).
4. Additional risk factors for failed VAD included: Occiput posterior position (OR = 2.45, 95% CI 1.6-3.7, p < 0.001); Fetal head station less than 2 cm below the ischial spine (OR = 1.92, 95% CI 1.4-2.7, p < 0.001); duration of the second stage of delivery > 3.5 hours (OR = 1.92, 95% CI 1.4-2.7, p < 0.001); birth weight > 3,500 grams (OR = 1.77, 95% CI 1.3-2.5, p < 0.001); induction of labor (OR = 1.95, 95% CI 1.4-2.7, p < 0.001); meconium stained amniotic fluid (OR = 1.52, 95% CI 1.1-2.2, p = 0.018); Male gender (OR = 1.18, 95% CI 1.0-2.0, p = 0.042).

 

Conclusion:

In addition to well-known risk factors for failed VAD, clinical chorioamnionitis was found to be the main factor associated with an increased risk of vacuum failure.