When Pushing Is Not Enough: A Novel Description of Maternal Characteristics and Delivery Outcome.

Abstract

Objective: Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for MEX and evaluates maternal and neonatal outcomes compared to other indications.

Study design: A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: Those with MEX (group 1) and those without (group 2). Statistical analyses included chi-square tests, t-tests, Mann-Whitney tests, and multivariable logistic regression.

Results: Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75 vs. 71%, p = 0.028), have gestational diabetes (7.7 vs. 5.4%, p = 0.047), and use regional anesthesia (92.4 vs. 89.1%, p = 0.006). They also experienced longer labor durations, with a second stage averaging 2.86 hours versus 2.54 hours in the non-exhausted group (p < 0.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of MEX by 53% for each additional hour (OR = 1.53 [95% CI: 1.10-1.64]).

Conclusion: Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, VD for MEX was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor.

Key points: · Maternal exhaustion accounts for 30% of vacuum births.. · Higher maternal morbidity is observed in the exhaustion group.. · Neonatal outcomes are comparable between groups.. · Vacuum delivery for exhaustion remains a safe option.. · An intervention to reduce exhaustion is needed..