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Fetal rotation during vacuum extractions for prolonged labor : a prospective cohort study

Kahrs, Birgitte H.; Usman, Sana; Ghi, Tullio; Youssef, Aly; Torkildsen, Erik A.; Lindtjørn, Elsa; Østborg, Tilde B.; Benediktsdottir, Sigurlaug LU ; Brooks, Lis and Harmsen, Lotte, et al. (2018) In Acta Obstetricia et Gynecologica Scandinavica 97(8). p.998-1005
Abstract

Introduction: The aim of the study was to investigate fetal head rotation during vacuum extraction. Material and methods: We conducted a prospective cohort study from November 2013 to July 2016 in seven European hospitals. Fetal head position was determined with transabdominal or transperineal ultrasound and categorized as occiput anterior (OA), occiput transverse (OT) or occiput posterior (OP) position. Main outcome was the proportion of fetuses rotating during vacuum extraction. Secondary outcomes were conversion of delivery method, duration of vacuum extraction, umbilical artery pH <7.10 and agreement between clinical and ultrasound assessments. Results: The study population comprised 165 women. During vacuum extraction 117/119... (More)

Introduction: The aim of the study was to investigate fetal head rotation during vacuum extraction. Material and methods: We conducted a prospective cohort study from November 2013 to July 2016 in seven European hospitals. Fetal head position was determined with transabdominal or transperineal ultrasound and categorized as occiput anterior (OA), occiput transverse (OT) or occiput posterior (OP) position. Main outcome was the proportion of fetuses rotating during vacuum extraction. Secondary outcomes were conversion of delivery method, duration of vacuum extraction, umbilical artery pH <7.10 and agreement between clinical and ultrasound assessments. Results: The study population comprised 165 women. During vacuum extraction 117/119 (98%) remained in OA and two fetuses rotated to OP position. Rotation from OT to OA position occurred in 14/19 (74%) and to OP position in 5/19 (26%). Rotation from OP to OA position occurred in 15/25 (60%), and 10/25 (40%) fetuses remained in OP position. Delivery information was missing in two cases. The conversion rate from vacuum extraction to cesarean section or forceps was 10% in the OA group vs. 23% in the non-OA group; p < 0.05. The estimated duration of vacuum extraction was significantly shorter in OA fetuses, 7 min vs. 10 min (log rank test p < 0.01). There was no significant difference in umbilical artery pH < 7.10 between OA and non-OA position. Cohens Kappa of agreement between clinical and ultrasound assessments was 0.42 (95% CI 0.26–0.57). Conclusion: Most fetuses in OP or OT positions rotated to OA position during vacuum extraction, but the proportion of failed vacuum extractions remained high.

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publication status
published
subject
keywords
delivery, fetal rotation, prolonged labor, ultrasound, vacuum extraction
in
Acta Obstetricia et Gynecologica Scandinavica
volume
97
issue
8
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85050129154
ISSN
0001-6349
DOI
10.1111/aogs.13372
language
English
LU publication?
yes
id
6d94452b-8fe2-49a2-b65b-f426e095162b
date added to LUP
2018-07-31 14:20:03
date last changed
2019-05-21 04:09:18
@article{6d94452b-8fe2-49a2-b65b-f426e095162b,
  abstract     = {<p>Introduction: The aim of the study was to investigate fetal head rotation during vacuum extraction. Material and methods: We conducted a prospective cohort study from November 2013 to July 2016 in seven European hospitals. Fetal head position was determined with transabdominal or transperineal ultrasound and categorized as occiput anterior (OA), occiput transverse (OT) or occiput posterior (OP) position. Main outcome was the proportion of fetuses rotating during vacuum extraction. Secondary outcomes were conversion of delivery method, duration of vacuum extraction, umbilical artery pH &lt;7.10 and agreement between clinical and ultrasound assessments. Results: The study population comprised 165 women. During vacuum extraction 117/119 (98%) remained in OA and two fetuses rotated to OP position. Rotation from OT to OA position occurred in 14/19 (74%) and to OP position in 5/19 (26%). Rotation from OP to OA position occurred in 15/25 (60%), and 10/25 (40%) fetuses remained in OP position. Delivery information was missing in two cases. The conversion rate from vacuum extraction to cesarean section or forceps was 10% in the OA group vs. 23% in the non-OA group; p &lt; 0.05. The estimated duration of vacuum extraction was significantly shorter in OA fetuses, 7 min vs. 10 min (log rank test p &lt; 0.01). There was no significant difference in umbilical artery pH &lt; 7.10 between OA and non-OA position. Cohens Kappa of agreement between clinical and ultrasound assessments was 0.42 (95% CI 0.26–0.57). Conclusion: Most fetuses in OP or OT positions rotated to OA position during vacuum extraction, but the proportion of failed vacuum extractions remained high.</p>},
  author       = {Kahrs, Birgitte H. and Usman, Sana and Ghi, Tullio and Youssef, Aly and Torkildsen, Erik A. and Lindtjørn, Elsa and Østborg, Tilde B. and Benediktsdottir, Sigurlaug and Brooks, Lis and Harmsen, Lotte and Salvesen, Kjell Å and Lees, Cristoph C. and Eggebø, Torbjørn M.},
  issn         = {0001-6349},
  keyword      = {delivery,fetal rotation,prolonged labor,ultrasound,vacuum extraction},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {998--1005},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Fetal rotation during vacuum extractions for prolonged labor : a prospective cohort study},
  url          = {http://dx.doi.org/10.1111/aogs.13372},
  volume       = {97},
  year         = {2018},
}