Vacuum, failed vacuum, and/or cesarean delivery for prolonged second stage do not impact differently on long-term health of the offspring

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

Research output: Contribution to journalMeeting Abstract


We aimed to evaluate whether an association exists between prolonged second stage of labor leading to vacuum and/or cesarean delivery (CD) and long-term morbidity of the offspring.

Study Design
A population based cohort analysis was performed comparing the risk of long-term composite morbidity (up to the age of 18 years) of children born following prolonged second stage of labor. Three groups were compared: successful vacuum extraction, CD following a failed vacuum attempt, and CD without a previous vacuum attempt. Composite morbidity included hospitalizations involving a pre-defined set of ICD-9 codes, including cardiac, respiratory, endocrinology, hematology, infectious, and urology related hospitalizations (according to hospital records). Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies and fetal congenital malformations were excluded. Kaplan-Meier survival curves were constructed to compare cumulative morbidity. Cox proportional hazards models were used to control for confounders including; gestational age, birthweight, and maternal factors.

During the study period, 3291 newborns met the inclusion criteria and were included in the long-term analysis. Of them, 38.2% (n=1257) underwent CD, 58.2% (n=1916) underwent a successful vacuum extraction, and 3.6% (n=118) underwent an unsuccessful vacuum attempt and a subsequent CD. Composite morbidity was comparable in all groups (Table) as was the cumulative incidence of each category of morbidity evaluated using a Kaplan-Meier survival curve (Figure, all log rank p values >0.05). In the Cox regression models neither failed nor successful vacuum delivery were associated with increased pediatric morbidity as compared with a primary CD (aHR in table).

Mode of delivery following prolonged second stage of labor including; successful vacuum, failed vacuum, and/or CD, does not appear to be associated with offspring's later health.
Original languageEnglish GB
Pages (from-to)S389-S389
JournalAmerican Journal of Obstetrics and Gynecology
Issue number1
StatePublished - Jan 2017


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