Use of Vacuum Extraction During Cesarean Delivery: Is It Safe? [7B]

INTRODUCTION: The complications of vacuum-assisted vaginal deliveries are well documented; however, complications with its use during cesarean delivery (CD) is limited. The objective of the study is to determine if there is an increased risk of maternal and neonatal morbidity in vacuum-assisted CD. METHODS: This is a retrospective cohort study of vacuum-assisted CD identified from a university-based surgical case log from 5/2014–7/2015. Term, singleton gestations with cephalic presentation vacuum-assisted CDs were matched 1:1 with non-vacuum-assisted CDs by CD type (primary or repeat). The 2 groups were compared with respect to maternal composite outcome (hysterotomy extension, postpartum hemorrhage, blood transfusion, SICU admission, hospital stay more than 5 days) and neonatal composite outcome (NICU admission, cephalohematoma, subgaleal hematoma, nerve injury, seizure, respiratory distress syndrome, jaundice, ventilation, fracture). Data was analyzed using parametric and non-parametric tests with a p less than 0.05 considered significant. RESULTS: Ninety-five vacuum-assisted CD were compared with 95 matched controls. The most common indication for vacuum use was “difficulty delivering the fetal head” (n=26/40). Baseline characteristics were not different. Vacuum-assisted CD was associated with increased adverse maternal composite outcome (OR 3.5; 95% CI 1.44–14.0, p = 0.01) but not adverse neonatal composite outcome (OR 1.89; 95% CI 0.98–3.62, p =0.06); however, neonatal jaundice was increased (18.9% vs 6.3%, p = 0.01). There were no major neonatal injuries or deaths in either group. CONCLUSION: Vacuum-assisted CD is associated with increased rates of maternal morbidity and neonatal jaundice.