Highlights
- •Data regarding instrumental deliveries in those with malformed uterus is scares.
- •In this study, maternal and neonatal outcomes in this population were examined.
- •Instrumental vaginal deliveries were associated with unfavorable maternal outcomes.
- •Aside from birth trauma, neonatal results did not differ between the groups.
- •These findings should be presented during consultations about modes of delivery.
Abstract
Objective
To evaluate the maternal and neonatal outcomes associated with vacuum-assisted vaginal
delivery (VAVD) in a subset of parturients with congenital uterine anomalies.
Study Design
A retrospective database study was conducted at a single tertiary center between 2005
and 2019. Parturients with known congenital uterine anomalies who had vaginal deliveries
were enrolled, whereas parturients with failed VAVD, didelphic uterus, and delivery
after intrauterine fetal death were excluded. Various maternal and neonatal outcomes
were compared between parturients who achieved spontaneous vaginal delivery (SVD)
and those who delivered via VAVD. The maternal composite outcome was calculated for
each group and included one or more of the following: post-partum hemorrhage, hemoglobin
drop ≥ 4 gr/dL, blood transfusions, retained placental products, and obstetric anal
sphincter injuries. Univariate analysis was performed followed by multivariate logistic
regression analysis controlling for potential confounders. Adjusted odds ratios (aORs)
and 95% confidence intervals (CIs) were calculated.
Results
After the application of the exclusion criteria, 332 parturients were found eligible.
Of those, 289 (87%) had SVD and 43 (13%) had VAVD. VAVD was more common among primiparous
parturients and epidural analgesia users. Parturients with VAVD had higher rates of
third-degree perineal tear, postpartum hemorrhage, and blood transfusions. The maternal
composite outcome was significantly more prevalent in the VAVD group (44.2% vs. 20.8%,
p < 0.01). After controlling for potential confounders, the maternal composite outcome
was found to be independently associated with VAVD (aOR 2.3, 95% CI 1.10–4.60). The
neonatal results were overall comparable, except for scalp trauma and Erb’s palsy/clavicular
fracture, which were more prevalent in the VAVD group.
Conclusion
In a special population of parturients with congenital uterine anomalies, VAVD was
found to be associated with significantly higher rates of adverse maternal outcomes
and perinatal birth trauma. These findings should be presented to parturients during
consultations about modes of delivery.
Keywords
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References
K.L.P.T. Moore The Urogenital System. Before We Are Born: Essential of Embryology and Birth Defects 7th ed.; 2008
The American Fertility Society classifications of adnexal adhesions distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions Fertil Steril. 49 6 1988 944 955 10.1016/s0015-0282(16)59942-7
- The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies.Hum Reprod. 2013; 28: 2032-2044https://doi.org/10.1093/humrep/det098
- Complex malformations of the female genital tract. New types and revision of classification.Hum Reprod. 2004; 19: 2377-2384https://doi.org/10.1093/humrep/deh423
- The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review.Hum Reprod Update. 2011; 17: 761-771https://doi.org/10.1093/humupd/dmr028
- Type of congenital uterine anomaly and adverse pregnancy outcomes.J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2014; 27: 949-953https://doi.org/10.3109/14767058.2013.847082
- Trial of labor and vaginal birth after cesarean section in patients with uterine Müllerian anomalies: a population-based study.Am J Obstet Gynecol. 2007; 196: 537.e1-537.e11https://doi.org/10.1016/j.ajog.2007.01.012
- Reproductive outcomes in women with congenital uterine anomalies: a systematic review.Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2011; 38: 371-382https://doi.org/10.1002/uog.10056
- Operative vaginal delivery - An historical perspective.Best Pract Res Clin Obstet Gynaecol. 2019; 56: 3-10https://doi.org/10.1016/j.bpobgyn.2018.08.002
- Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.BJOG. 2013; 120: 1516-1525https://doi.org/10.1111/1471-0528.12363
- Morbidity experienced by women before and after operative vaginal delivery: prospective cohort study nested within a two-centre randomised controlled trial of restrictive versus routine use of episiotomy.BJOG. 2013; 120: 1020-1026https://doi.org/10.1111/1471-0528.12184
- Effect of mode of delivery in nulliparous women on neonatal intracranial injury.N Engl J Med. 1999; 341: 1709-1714https://doi.org/10.1056/NEJM199912023412301
- Mode of delivery at term and adverse neonatal outcomes.Obstet Gynecol. 2013; 121: 122-128https://doi.org/10.1097/aog.0b013e3182749ac9
- Long-term neurological sequelae following vacuum extractor delivery.Aust N Z J Obstet Gynaecol. 1990; 30: 111-114https://doi.org/10.1111/ajo.1990.30.issue-210.1111/j.1479-828X.1990.tb03237.x
Clinical implications of uterine malformations and hysteroscopic treatment results | Human Reproduction Update | Oxford Academic. https://academic-oup-com.szmc-ez.medlcp.tau.ac.il/humupd/article/7/2/161/638048. Accessed July 16, 2020.
RCOG. Operative Vaginal Delivery - Green-top Guideline No. 26. 2011;(26):19. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_26.pdf.
- 165 Summary: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Obstet Gynecol. 2016; 128: 226-227https://doi.org/10.1097/AOG.0000000000001521
- Episiotomy in vacuum-assisted delivery affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis.Eur J Obstet Gynecol Reprod Biol. 2016; 207: 193-199https://doi.org/10.1016/j.ejogrb.2016.10.013
- The Apgar score in the 21st century.N Engl J Med. 2001; 344: 519-520https://doi.org/10.1056/NEJM200102153440709
GG N. Uterine anomalies. How common are they, and what is their distribution among subtypes? J Reprod Med. 1998;43(10):877-887. https://europepmc.org/article/med/9800671. Accessed August 15, 2021.
- Clinical implications of uterine malformations and hysteroscopic treatment results.Hum Reprod Update. 2001; 7: 161-174https://doi.org/10.1093/HUMUPD/7.2.161
- Pregnancy outcome in women with müllerian duct anomalies.J Reprod Med. 1990; 35: 411-414
Ravasia DJ, Brain PH, Pollard JK. Incidence of uterine rupture among women with mullerian duct anomalies who attempt vaginal birth after cesarean delivery. In: American Journal of Obstetrics and Gynecology. Vol 181. Mosby Inc.; 1999:877-881. doi:10.1016/S0002-9378(99)70318-2
- The association between Mullerian anomalies and short-term pregnancy outcome.J Matern Neonatal Med. 2016; : 1-6https://doi.org/10.3109/14767058.2015.1098613
- The association between Müllerian anomalies and perinatal outcome.J Matern Neonatal Med. 2019; 32: 51-57https://doi.org/10.1080/14767058.2017.1370703
- Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery.Arch Gynecol Obstet. 2017; 295: 75-80https://doi.org/10.1007/s00404-016-4208-5
- Epidural analgesia as a risk factor for operative delivery.Int J Gynecol Obstet. 1996; 53: 125-132https://doi.org/10.1016/0020-7292(95)02641-X
- Epidural analgesia as a risk factor for operative delivery.Int J Gynecol Obstet. 1996; 53: 125-132https://doi.org/10.1016/0020-7292(95)02641-X
- Effect of Growth Restriction on Fetal Heart Rate Patterns in the Second Stage of Labor.Am J Perinatol. 2015; 32: 873-878https://doi.org/10.1055/s-0000000910.1055/s-005-2983010.1055/s-0034-1543954
- Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction).J Matern Neonatal Med. 2017; 31: 1-7https://doi.org/10.1080/14767058.2017.1344631
Article info
Publication history
Published online: August 25, 2021
Accepted:
August 23,
2021
Received in revised form:
August 17,
2021
Received:
July 5,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
