title: The association between fetal head position prior to vacuum extraction and pregnancy outcome.
abstract: OBJECTIVE
  To estimate the association of fetal head position prior to vacuum extraction (VE) and pregnancy outcome.
  
  
  METHODS
  A retrospective cohort study of singleton pregnancies who underwent VE. Pregnancy outcome of occipito-anterior (OA) position of the fetal head was compared to those with occipito-posterior (OP) position.
  
  
  RESULTS
  Amongst overall 12,063 women undergoing trial of labor, there were 1118 (9.2%) VE deliveries. Of them, 871 (77.9%) had OA and 247 (22.1%) had OP position of the fetal head. Except for a higher rate of nulliparity in the OA group, no significant differences between the groups regarding pregnancy complications and birthweight were noted. In the OP group, there were higher rates of prolonged 2nd-stage of labor as an indication for VE (49.8 vs. 36.5%, p < 0.001) and single detachment of vacuum cup (11.3 vs. 6.7%, p = 0.02) without any increased risk of failed extraction. Higher risks for sub-galeal hematoma (aOR = 4.36, p = 0.03) and low 5-min Apgar score (aOR = 4.63, p = 0.02) were observed in the OP group with otherwise similar rates of adverse maternal and neonatal outcomes.
  
  
  CONCLUSIONS
  Among women undergoing VE, OP position is associated with higher rate of vacuum cup detachment, low 5-min Apgar score and increased risk for sub-galeal hematoma with otherwise similar rates of adverse maternal and neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Avital
authors.initials: A
authors.lastname: Wertheimer
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Aviram
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hudi
authors.initials: H
authors.lastname: Pauzner
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Wiznitzer
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 49100, Petach Tikva, Israel. lirhir@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. lirhir@gmail.com.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005333:Fetus; D006257:Head; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*
keywords: Adverse outcome; Delivery; Occipito-posterior position; Operative delivery; Vacuum extraction