Mode of delivery following prolonged second stage of labor: Does it affect the long-term neurological outcome of the offspring?

Asnat Walfisch, Tamar Wainstock, Idit Segal, Daniella Landau, Eyal Sheiner

Research output: Contribution to journalMeeting Abstract


Concerns exist with regards to long term developmental outcome of the offspring following vacuum delivery. We aimed to evaluate an association between prolonged second stage of labor leading to vacuum and/or cesarean delivery (CD) and long-term neurological morbidity of the offspring.

Study Design
A population based cohort analysis was performed comparing the risk of long-term neurological morbidity (up to the age of 18 years) of children born following non-progressive labor of the second stage. Three groups were compared: successful vacuum extraction, CD, and CD following a failed vacuum attempt. Neurological morbidity included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in the hospital records. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative neurological morbidity. A Cox proportional hazards model was used to control for confounders including; gestational age, birthweight, and maternal factors.

During the study period 3291 newborns met the inclusion criteria; 38.2% (n=1257) underwent a cesarean section, 58.2% (n=1916) underwent a successful vacuum delivery, and 3.6% (n=118) underwent an unsuccessful vacuum attempt and a subsequent CD. Neurological morbidity was comparable in all groups (Table) as was the cumulative incidence of total neurological morbidity using a Kaplan-Meier survival curve (Log rank p=0.6, Figure). In the Cox regression model neither failed nor successful vacuum delivery were associated with increased pediatric neurological morbidity as compared with a primary CD (aHR 0.94, 95% CI 0.6-1.4, p=0.8 and aHR 1.5, 95% CI 0.6-3.5, p=0.4, respectively).

Mode of delivery following prolonged second stage of labor including successful vacuum, failed vacuum, and/or cesarean delivery does not appear to impact differently on the long-term neurological outcome of the offspring.
Original languageEnglish GB
Pages (from-to)S234-S234
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2018


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