Figure 3 – Mode of delivery The majority of vacuums were performed in nulliparous women: 71.8%. Another 12.9% were having their second child and the remaining 15% were para 3 or above. Guidelines indicate that the fetus should not be premature if vacuum is to be attempted. The generally accepted weight cut off for this is 2500g. A total of 18 babies (5.6%) were <2500g. This was presumably due to misjudgement of the size of the baby (half were ≥2200g) but this aspect was not analysed further, although it provides an important learning point. The indication for vacuum was not well recorded in the delivery register (only ¼ of the time), but of those, recorded indications were for prolonged second stage, fetal distress or poor maternal effort in a 6:1:1 ratio. Fetal outcomes Initial Apgar scores were ≥8 in 65.1%, 5-7 in 24.1% and <5 in 10.5% of successful deliveries, but this improved markedly to 90.8% ≥8 by 5 minutes, while 7.6% were 5-7 and only 1.3% <5. Of the four cases who had 5-minute Apgars of <5, three resulted in ENNDs. (Three babies who were IUDs but delivered by vacuum were excluded from the Apgar analysis.) The spread of Apgar scores at 1 and 5 minutes differed between practitioners, but all except one had an 80% rate of Apgars ≥8 by 5 minutes. (There were no 5-minute Apgars <5 for this doctor, however.) Further details of this sub-analysis are available but not included here due to space. Figure 4: Apgar scores at 1 minute Figure 5: Apgar score at 5 minutes
Figure 3 – Mode of delivery The majority of vacuums were performed in nulliparous women: 71.8%. Another 12.9% were having their second child and the remaining 15% were para 3 or above. Guidelines indicate that the fetus should not be premature if vacuum is to be attempted. The generally accepted weight cut off for this is 2500g. A total of 18 babies (5.6%) were <2500g. This was presumably due to misjudgement of the size of the baby (half were ≥2200g) but this aspect was not analysed further, although it provides an important learning point. The indication for vacuum was not well recorded in the delivery register (only ¼ of the time), but of those, recorded indications were for prolonged second stage, fetal distress or poor maternal effort in a 6:1:1 ratio. Fetal outcomes Initial Apgar scores were ≥8 in 65.1%, 5-7 in 24.1% and <5 in 10.5% of successful deliveries, but this improved markedly to 90.8% ≥8 by 5 minutes, while 7.6% were 5-7 and only 1.3% <5. Of the four cases who had 5-minute Apgars of <5, three resulted in ENNDs. (Three babies who were IUDs but delivered by vacuum were excluded from the Apgar analysis.) The spread of Apgar scores at 1 and 5 minutes differed between practitioners, but all except one had an 80% rate of Apgars ≥8 by 5 minutes. (There were no 5-minute Apgars <5 for this doctor, however.) Further details of this sub-analysis are available but not included here due to space. Figure 4: Apgar scores at 1 minute Figure 5: Apgar score at 5 minutes
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