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Poster Session 3

Category: Labor

Poster Session 3

(991) Parity-Dependent Outcomes and Procedural Dynamics in Non Reassuring Fetal Heart rate (NRFHR) indicated vacuum-Assisted Deliveries

Thursday, February 12, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Yael Shalev-Rosenthal, MD, MPH (she/her/hers)

'Rabin medical center'
Rabin medical center/ Petach tikwa, HaMerkaz, Israel

Coauthor(s)

Bar Narkis, MD, MPH (she/her/hers)

Resident
Helen Schneider Hospital for Women, Rabin Medical Center
Petah Tikva, HaMerkaz, Israel
Anat Pardo, MD (she/her/hers)

MFM Fellow
Rabin Medical Center
Petach Tikva, HaMerkaz, Israel
Or Bercovich, BSc, MD (he/him/his)

Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, HaMerkaz, Israel
LF

Lior Friedrich, MD

Intern
Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
Petah Tikva, HaMerkaz, Israel

Objective:
To compare maternal and neonatal outcomes, as well as procedural characteristics, of vacuum-assisted deliveries (VAD) for non-reassuring fetal heart rate (NRFHR) between primiparous and multiparous individuals.

Study Design:
This retrospective cohort study included patients who underwent VAD for NRFHR between 2012 and 2024. Participants were stratified by parity—primiparas versus multiparas. Maternal and neonatal outcomes were compared, along with procedural characteristics such as fetal head station, head position at vacuum initiation, and procedure duration. Analyses were performed using univariate comparisons and multivariate logistic regression.

Results:
Among 3833 individuals, 2908 were primiparas and 925 multiparas. Despite less favorable fetal head conditions in multiparas—higher rates of station S+1 at vacuum application (61.1% vs. 43.4%, p< 0.01) and a trend toward more occiput posterior positions (30.9% vs. 19.1%, p=0.078)—procedure duration was shorter in this group (171 vs. 207 sec, p< 0.01). Maternal outcomes were significantly better in multiparas, with a lower composite complication rate (adjusted OR 0.37, 95% CI: 0.24–0.59). The maternal composite outcome included postpartum hemorrhage, blood transfusion, and severe perineal tears. Neonatal outcomes—including Apgar scores, cord pH, NICU admission, and skull-related complications—were comparable between groups.

Conclusion:
Multiparas undergoing VAD for NRFHR had reduced maternal morbidity and shorter procedures, despite less favorable fetal head conditions. The shorter operative time may reflect better physiological feasibility in multiparous patients. Additionally, the willingness to proceed with VAD under suboptimal conditions may suggest that clinicians feel more confident performing operative deliveries in women with prior vaginal births. These findings underscore the importance of considering both patient-specific physiological factors and clinician-related decision-making behaviors when evaluating the appropriateness and safety of vacuum-assisted deliveries.