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Poster Session I Thursday, February 1 • 10:30 AM - 12:00 PM • Trinity Exhibit Hall| Volume 218, ISSUE 1, SUPPLEMENT , S121, January 01, 2018

176: Are maternal and neonatal complications associated with the number of pop-offs during vacuum-assisted vaginal delivery (VAVD)?

      Objective

      VAVDs account for approximately 4% of vaginal births in the US and the incidence of serious neonatal complications with VAVD is approximately 5%. There is limited literature on the maternal and neonatal outcomes associated with the number of involuntary detachments (pop-offs) of the cup during VAVDs. Most experts recommend limiting pop-offs to three before abandoning the procedure, however, there are no standard guidelines. Our objective was to evaluate outcomes among successful VAVDs in relation to the number of pop-offs during the deliveries.

      Study Design

      This was a retrospective cohort analysis of patients undergoing successful VAVD in seven New York hospitals from January 2015 to December 2016. Data was abstracted from a de-identified database maintained by the risk management advisor/malpractice insurer for these institutions, which performs quarterly chart audits of all VAVD deliveries. Inclusion criteria: single gestations in cephalic presentation at >34 weeks of gestation. Maternal and neonatal outcomes were analyzed using standard univariate analyses.

      Results

      611 cases of VAVDs were reviewed. Number of pop-offs are as follows: Zero among 398 (65.1%) cases, one among 147 (24.1%) cases, two among 57 (9.3%) cases and three among 9 (1.5%) cases. When comparing VAVDs with any pop-off (≥1) to those with zero pop-offs, there was significantly higher risk of NICU admission (11.3% vs. 6.5%, p=0.04), Apgar <7 at 1 minute (10.8% vs. 5%, p=0.01), need for neonatal intubation (2.3% vs. 0.3%, p=0.02) or any neonatal resuscitation (10.3% vs. 4.5%, p=0.009). When comparing VAVD with ≥ 2 pop-offs to those with <2 pop-offs, there was significantly higher risk of major head trauma (subgaleal hemorrhage, skull fracture and intracranial hemorrhage) (4.5% vs. 0.7%, p=0.03) and need for neonatal intubation (4.5% vs. 0.5%, p=0.01). There was no difference in both analyses with regards to maternal complications, including PPH, blood transfusion and 3rd or 4th degree perineal lacerations.

      Conclusion

      There is significant neonatal morbidity associated with increasing number of pop-offs during VAVD. Clinicians should counsel and manage patients undergoing VAVD accordingly.