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Operative vacuum vaginal delivery: effect of compliance with recommended checklist.

Authors
  • Pintucci, Armando1
  • Consonni, Sara1
  • Lambicchi, Laura2
  • Vergani, Patrizia2
  • Incerti, Maddalena2
  • Bonati, Francesca1
  • Locatelli, Anna3
  • 1 Department of Obstetrics and Gynecology, ASST Vimercate, Carate, Italy. , (Italy)
  • 2 Department of Obstetrics and Gynecology, FMBBM Foundation, University of Milano-Bicocca, Monza, Italy. , (Italy)
  • 3 Department of Obstetrics and Gynecology, University of Milano-Bicocca, ASST Vimercate, Carate, Italy. , (Italy)
Type
Published Article
Journal
The Journal of Maternal-Fetal & Neonatal Medicine
Publisher
Informa UK (Taylor & Francis)
Publication Date
May 01, 2021
Volume
34
Issue
10
Pages
1627–1633
Identifiers
DOI: 10.1080/14767058.2019.1643312
PMID: 31390914
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Even if the prerequisites and the technique of vacuum extraction are largely established, the role of a checklist in this field has not been tested. To evaluate the role of a checklist implementation on the compliance with the recommended rules in operative vacuum vaginal delivery (OVD) and on maternal and perinatal outcomes. Retrospective cohort study on OVD between January 2012 and December 2015 at two hospitals with a tradition of teaching of OVD. A checklist for OVD was introduced in 2014. Three rules had to be recorded: fetal head station and position determination, no more than four tractions, and no more than three cup applications. Adverse maternal outcomes included third- and fourth-degree perineal tears. Adverse neonatal outcome included asphyxia, need for neonatal resuscitation, NICU admission, major head injuries, scalp injuries, and bone or brachial plexus injuries. Introduction of a checklist for OVD resulted in an increase in the compliance with the rules (83.3 versus 62.8%, p < .001). Cases in which the rules were respected had lower incidence of third- and fourth-degree perineal lacerations after controlling for episiotomy, nulliparity, and indication for OVD (OR = 0.4, 95% CI 0.18-0.89), but similar rates of failure of OVD (2.1 versus 2.2%, p = 1) and adverse neonatal outcome (10.8 versus 11.7%, p=.71). Knowledge and documented compliance with a checklist of recommended rules in OVD may assist in achieving a lower rate of severe perineal and anal sphincter injury but does not alter the success of the procedure or neonatal outcome.

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