(658) Closed- or open-glottis pushing for vaginal delivery: a planned secondary analysis of the TRAAP study.

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To assess the mode of delivery and the maternal and neonatal outcomes after an attempted singleton vaginal birth at or near term according to the open- or closed-glottis pushing.

Study Design: Ancillary planned cohort study of the TRAAP randomized controlled trial, conducted in fifteen French maternity units between 2015-2016. Women who underwent an attempted singleton vaginal delivery after 35 weeks’ gestation were enrolled. After randomization, characteristics of labor and delivery were prospectively collected, and the second-stage pushing was assessed with a planned dedicated questionnaire fulfilled immediately after birth by the attending care provider. The main endpoint was the rate of operative vaginal delivery. Secondary endpoints were maternal morbidity neonatal morbidity, immediate maternal satisfaction and experience of delivery, and psychological status two months after delivery. Analyzes were performed by multivariate multilevel mixed-effect logistic regression with the random effect on the center.

Results: Among 3,041 women included in our main analysis, 2,463 (81.0%) pushed in closed- and 578 (19.0%) pushed with open-glottis. In univariate analysis, the operative vaginal delivery rate was 19.1% (n=471, 95%CI 17.6-20.7) and 12.5% (n=72, 95%CI 9.9-15.4) among respectively closed- and open-glottis group (P= < 0.001). In a subgroups analysis according to parity and after controlling for confounding bias, operative vaginal delivery rates did not differ between groups among nulliparous women (aOR 0.92 95%CI 0.64-1.31, P=0.6), but was significantly lower for open- compared with closed pushing among multiparous women (aOR 0.42 95%CI 0.19-0.92, P=0.03). Other maternal or neonatal outcomes did not differ between the two groups.

Conclusion: In singleton pregnancies at or near term, pushing in open-glottis was associated with lower risk of operative vaginal delivery among

multiparous women after controlling for confounding bias. These results should help care providers to guide women for the choice of the mode of pushing method in a share-decision making.

Primary & Presenting Author(s)

Alizée Froeliger, MD MPH (she/her/hers)
Department of Obstetrics and Gynecology, Bordeaux Universitary Hospital
Bordeaux, Aquitaine, France

Coauthor(s)

CD
Catherine Deneux-Tharaux, MD, PhD
Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, DHU Risks in Pregnancy
Paris, France, France
Hugo Madar, MD, MPH (he/him/his)
Department of Obstetrics and Gynecology, Bordeaux Universitary Hospital
Bordeaux, Aquitaine, France
Hanane Bouchghoul, MD, PhD
Department of Obstetrics and Gynecology, Bordeaux Universitary Hospital
Bordeaux, Aquitaine, France
Camille Le Ray, MD, PhD
APHP, Port Royal Maternity Unit
Paris, France, France
Loïc Sentilhes, MD, PhD (he/him/his)
Head of Department of Obstetrics and Gynecology
Department of Obstetrics and Gynecology, Bordeaux Universitary Hospital
Aquitaine, Aquitaine, France