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Am J Perinatol 2023; 40(03): 274-278
DOI: 10.1055/s-0041-1728824
Original Article

The Association between the Number of Vacuum Pop-Offs and Adverse Neonatal Outcomes

Allie Sakowicz 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Salwa J. Zahalka
2   Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
,
Emily S. Miller
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding E.S.M. was supported by NIHCD K12 HD050121-09 at the time of study.
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Abstract

Objective Obstetrical vacuum manufacturers have long recommended a maximum of two to three pop-offs be allowed before abandoning the procedure. However, there is a paucity of evidence on the safety of vacuum-assisted vaginal delivery in relation to the number of pop-offs to support this recommendation. Our objective was to examine whether the number of pop-offs in a vacuum-assisted vaginal delivery was associated with adverse neonatal outcomes.

Study Design This is a retrospective cohort study of women who underwent a trial of a vacuum-assisted vaginal delivery at a single tertiary care institution between October 2005 and June 2014. Maternal and fetal factors associated with the number of pop-offs were examined in bivariable analyses. Multivariable analyses were performed to determine the independent association of the number of pop-offs with adverse neonatal outcomes.

Results Of the 1,730 women who met inclusion criteria, 1,293 (74.7%) had no pop-offs, 240 (13.9%) had one pop-off, 128 (7.4%) had two pop-offs, and 69 (4.0%) had three or more pop-offs. Neonatal scalp/facial lacerations, intracranial hemorrhage, seizures, central nervous system depression, and neonatal intensive care unit admission were all associated with the number of pop-offs in bivariable analyses. In multivariable analyses, compared to no pop-offs, having any vacuum pop-offs was associated with an increased odds of adverse neonatal outcomes. However, there was not a consistent dose–response relationship.

Conclusion While having vacuum pop-offs in a vacuum-assisted vaginal delivery was associated with an increased risk of adverse neonatal outcomes, there did not appear to be a dose-dependent association with the number of pop-offs.

Key Points

  • There are no specific guidelines on how many pop-offs can be allowed before abandoning a vacuum-assisted vaginal delivery.

  • Having any vacuum pop-offs was associated with an increased risk of adverse neonatal outcomes.

  • There was no dose-dependent association between number of pop-offs and adverse neonatal outcomes.

Keywords

vacuum-assisted vaginal delivery - vacuum - pop-off - dislodgment - detachment - obstetrician

Note

This study was presented orally at the 38th annual meeting of the Society for Maternal–Fetal Medicine, Dallas, TX, January 29–February 3, 2018.




Publication History

Received: 22 October 2020

Accepted: 02 March 2021

Article published online:
03 May 2021

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