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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award

Poster Session 1

(319) Mild Fundal Pressure versus Vacuum Extraction to Shorten the Second Stage of Labor

Thursday, January 30, 2025
10:30 AM - 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Omri Dominsky, MD (he/him/his)

    OB\GYN resident
    Tel Aviv Sourasky Medical Center
    Tel Aviv Sourasky Medical Center, HaMerkaz, Israel

    • Coauthor(s)

  • Roza Berkovitz-Shperling, MD, MPH

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

  • Itamar Gilboa, MD

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

  • YY

    Yariv Yogev, MD

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

  • AL

    Anat Lavie, MD

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

Objective: To compare the efficacy and safety of mild fundal pressure (FP) versus vacuum extraction (VE) for shortening the 2nd stage of labor and the impact on maternal and neonatal outcomes.

Study Design:

Retrospective cohort study in a university affiliated medical center with approximately 12,500 annual deliveries (2022-2024). Women with singleton pregnancies requiring shortening of the 2nd stage for medical reasons (non-reassuring fetal heart rate or prolonged 2nd stage) were divided into 2 groups: those who received FP and those who underwent VE. Deliveries involving both VE and FP were excluded. Decisions were made based on physician’s preference.

Mild FP is performed at our hospital by trained obstetricians only after patient consent. The primary outcome was the duration of the 2nd stage of labor. Secondary outcomes included maternal and neonatal complications: 3rd–4th degree tears, postpartum hemorrhage, Apgar score, umbilical arterial cord pH < 7.1, and hospitalization duration.

Results:

1. During the study, 15,088 delivered vaginally, 1365 (9%) had FP and 624 (4.1%) underwent VE.

2. The 2nd stage of labor was shorter in the FP group (P < 0.001).

3. The rate of 3rd–4th degree tears was higher In the VE group (P=0.005).

4. Hemoglobin decline and maternal hospitalization duration were lower in the FP group (P < 0.001).

5. Neonatal outcomes showed no significant differences in Apgar scores. However, the FP group had a lower incidence of umbilical arterial cord pH < 7.1 and shorter neonatal hospitalization (P < 0.001).

6. Multivariate analysis showed significant increased risk in the VE group for 2nd stage duration (aOR 1.3), 3rd–4th degree tears (aOR 4.4), Hemoglobin decline (aOR 1.4), maternal hospitalization (aOR 1.0), and umbilical artery cord pH < 7.1 (aOR 3.5).

Conclusion:

Mild FP compared with VE may be associated with better maternal and neonatal outcomes, including a shorter 2nd stage of labor, fewer 3rd–4th degree tears, less hemoglobin decline, better umbilical cord pH, and shorter hospitalization for both mother and neonate. It is a safe and effective method when performed by a trained physician.