Abstract

Vacuum-assisted vaginal delivery might be a high-risk procedure both for women and new-borns. Our study had the aim was to assess appropriateness of the procedure. We conducted a prospective, longitudinal, observational study in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). Term pregnant women, either nulliparous and multiparous, with singleton pregnancy and a cephalic fetus, with spontaneous or induced labour, requiring vacuum- assisted delivery were enrolled. Indications to operative vaginal delivery were grouped as alterations of fetal cardiotocography (CTG) patterns, delay/arrest of second stage of labour or elective shortening of second stage of labour. A board consisting of five among authors evaluated appropriateness of the procedure. Overall, 466 women undergoing operative vaginal deliveries were included. Pathological cardiotocography, classified as ACOG category 2 or 3 was the indication for vacuum assisted delivery in 253 patients (54.29 %). Among these, 66 women (26.1 %) had an operative vaginal delivery which was then considered to be inappropriate, while in 114 cases (45.1 %) CTG traces resulted to be unreadable. In a situation of much uncertainty, the majority of operators chose a prompt intervention instead of better understanding what really happening. Doctors used a heuristic that we named “to get the baby out off the hook”. A heuristic is a mental short cut that can be very effective, but can lead to incorrect actions. We believe that this decision-making procedure is not beneficial, whereas the choice of better understanding could help the operator to process more information before the clinical choice.

Keywords

Cardiotocography