Vacuum extraction in twin deliveries—maternal and neonatal consequences: a retrospective cohort study

Purpose: To establish the frequency of vacuum extraction among parturients with twin pregnancies, identify the risk factors and perinatal outcomes. Methods: A retrospective cohort database study was conducted between 2005–2018. Twin fetuses with vertex presentation >34 weeks gestation who achieved vaginal delivery were included. Outcomes were compared between neonates who were delivered by vacuum extraction and neonates delivered by spontaneous vaginal delivery (aORs; [95% CI]). Results: A total of 1751 neonates of 905 parturients with twin pregnancies met inclusion criteria, of which 163 (18%) parturients had vacuum extraction and 225 (12.8%) neonates were delivered by vacuum extraction. The most significant risk factors for vacuum extraction were primiparity (6.79 [4.77–9.66]), previous cesarean delivery (5.59 [3.13–9.97]), and epidural analgesia (4.34 [1.83–10.31]). Vacuum extractions were associated with a spectrum of adverse maternal outcomes (2.60 [1.61–4.19]), particularly postpartum hemorrhage and its associated morbidities. From the neonatal aspect, vacuum extraction deliveries were associated with a composite of birth trauma injuries (21.81 [6.43–73.91]). Conclusion: Vacuum extractions among twin pregnancies were found to be associated with significantly higher rates of postpartum hemorrhage, blood transfusion, and perinatal birth trauma. These findings should be presented to women when counseling on mode of delivery and considered individually against cesarean delivery disadvantages.