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

Research output: Contribution to journalArticle

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 (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.

Details

Authors
  • Birgitte H. Kahrs
  • Sana Usman
  • Tullio Ghi
  • Aly Youssef
  • Erik A. Torkildsen
  • Elsa Lindtjørn
  • Tilde B. Østborg
  • Sigurlaug Benediktsdottir
  • Lis Brooks
  • Lotte Harmsen
  • Kjell Å Salvesen
  • Cristoph C. Lees
  • Torbjørn M. Eggebø
Organisations
External organisations
  • St. Olav’s University Hospital
  • Norwegian University of Science and Technology
  • Imperial College London
  • Parma University Hospital
  • St. Orsola-Malpighi University Hospital
  • Stavanger University Hospital
  • Hvidovre Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Obstetrics, Gynecology and Reproductive Medicine

Keywords

  • delivery, fetal rotation, prolonged labor, ultrasound, vacuum extraction
Original languageEnglish
Pages (from-to)998-1005
Number of pages8
JournalActa Obstetricia et Gynecologica Scandinavica
Volume97
Issue number8
Publication statusPublished - 2018 Aug 1
Publication categoryResearch
Peer-reviewedYes