{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:54:17Z","timestamp":1790898857915,"version":"4.1.0"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for MEX and evaluates maternal and neonatal outcomes compared to other indications.<\/jats:p>\n                  <jats:p>A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: Those with MEX (group 1) and those without (group 2). Statistical analyses included chi-square tests, t-tests, Mann\u2013Whitney tests, and multivariable logistic regression.<\/jats:p>\n                  <jats:p>Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75 vs. 71%, p\u2009=\u20090.028), have gestational diabetes (7.7 vs. 5.4%, p\u2009=\u20090.047), and use regional anesthesia (92.4 vs. 89.1%, p\u2009=\u20090.006). They also experienced longer labor durations, with a second stage averaging 2.86\u2009hours versus 2.54\u2009hours in the non-exhausted group (p\u2009&lt;\u20090.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of MEX by 53% for each additional hour (OR\u2009=\u20091.53 [95% CI: 1.10\u20131.64]).<\/jats:p>\n                  <jats:p>Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, VD for MEX was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor.<\/jats:p>","DOI":"10.1055\/a-2837-0136","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:26:57Z","timestamp":1773966417000},"page":"1892-1897","source":"Crossref","is-referenced-by-count":0,"title":["When Pushing Is Not Enough: A Novel Description of Maternal Characteristics and Delivery Outcome"],"prefix":"10.1055","volume":"43","author":[{"given":"Naama","family":"Farago","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal","family":"Bachar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avia","family":"Amir","sequence":"additional","affiliation":[{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Siegler","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Vitner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Khatib","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Beloosesky","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeev","family":"Weiner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaniv","family":"Zipori","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel"},{"name":"Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/01443610120101637","article-title":"Maternal and fetal risks associated with prolonged latent phase of labour","volume":"22","author":"J Maghoma","year":"2002","journal-title":"J Obstet Gynaecol"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"487.e1","DOI":"10.1016\/j.ajog.2019.05.041","article-title":"The transition from latent to active labor and adverse obstetrical outcomes","volume":"221","author":"J I Rosenbloom","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"445.e1","DOI":"10.1016\/j.ajog.2020.06.053","article-title":"Association of abnormal first stage of labor duration and maternal and neonatal morbidity","volume":"223","author":"S A Blankenship","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/AOG.0000000000003081","article-title":"ACOG Committee Opinion No. 766 Summary: Approaches to limit intervention during labor and birth","volume":"133","author":"American College of Obstetricians and Gynecologists","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"100325","DOI":"10.1016\/j.ajogmf.2021.100325","article-title":"Impact of therapeutic rest in early labor on perinatal outcomes: a prospective study","volume":"3","author":"M M Maykin","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1097\/AOG.0000000000003764","article-title":"Operative vaginal birth: ACOG Practice Bulletin, Number 219","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1111\/1471-0528.16092","article-title":"Assisted vaginal birth: Green-top Guideline No. 26","volume":"127","author":"D J Murphy","year":"2020","journal-title":"BJOG"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1097\/01.AOG.0000114985.22844.6d","article-title":"Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries","volume":"103","author":"J H Johnson","year":"2004","journal-title":"Obstet Gynecol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/bmj.329.7456.24","article-title":"Operative vaginal delivery and neonatal and infant adverse outcomes: Population based retrospective analysis","volume":"329","author":"K Demissie","year":"2004","journal-title":"BMJ"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"100339","DOI":"10.1016\/j.ajogmf.2021.100339","article-title":"Severe maternal and neonatal morbidity after attempted operative vaginal delivery","volume":"3","author":"D M Panelli","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"191.e1","DOI":"10.1016\/j.ajog.2018.10.028","article-title":"The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes","volume":"220","author":"Y Zipori","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/AOG.0000000000001246","article-title":"Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a workshop","volume":"127","author":"R D Higgins","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"267.e1","DOI":"10.1016\/j.ajog.2019.09.035","article-title":"Contemporary patterns of labor in nulliparous and multiparous women","volume":"222","author":"E Ashwal","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.ejogrb.2020.08.029","article-title":"The length of the second stage of labor in nulliparous, multiparous, grand-multiparous, and grand-grand multiparous women in a large modern cohort","volume":"253","author":"J I Rosenbloom","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ajog.2014.01.026","article-title":"Safe prevention of the primary cesarean delivery","volume":"210","author":"A B Caughey","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.ajog.2014.09.008","article-title":"Perils of the new labor management guidelines","volume":"212","author":"W R Cohen","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejogrb.2020.06.018","article-title":"Maternal and neonatal outcomes following a prolonged second stage of labor: A meta-analysis of observational studies","volume":"252","author":"V Pergialiotis","year":"2020","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"03","key":"ref18","first-page":"222","article-title":"Risk factors and outcome of failure to progress during the first stage of labor: a population-based study","volume":"81","author":"E Sheiner","year":"2002","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1111\/aogs.14592","article-title":"Gestational diabetes mellitus and time in active labor: A population-based cohort study","volume":"102","author":"S Nevander","year":"2023","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"614","DOI":"10.2174\/092986708783769786","article-title":"Potential biochemical events associated with initiation of labor","volume":"15","author":"A C Vidaeff","year":"2008","journal-title":"Curr Med Chem"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s00125-011-2371-6","article-title":"Diabetes is associated with impairment of uterine contractility and high caesarean section rate","volume":"55","author":"S Al-Qahtani","year":"2012","journal-title":"Diabetologia"},{"issue":"05","key":"ref22","first-page":"CD000331","article-title":"Epidural versus non-epidural or no analgesia for pain management in labour","volume":"5","author":"M Anim-Somuah","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1080\/14767058.2016.1174999","article-title":"Prolonged second stage in nulliparous with epidurals: A systematic review","volume":"30","author":"A C Gimovsky","year":"2017","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/(SICI)1098-0997(2000)8:2<77::AID-IDOG3>3.0.CO;2-6","article-title":"Prevalence and clinical significance of postpartum endometritis and wound infection","volume":"8","author":"W Chaim","year":"2000","journal-title":"Infect Dis Obstet Gynecol"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"S1274","DOI":"10.1016\/j.ajog.2022.11.002","article-title":"Maternal fever in labor: Etiologies, consequences, and clinical management","volume":"228","author":"L Goetzl","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1016\/S0140-6736(19)30773-1","article-title":"Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial","volume":"393","author":"M Knight","year":"2019","journal-title":"Lancet"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2837-0136.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:06:19Z","timestamp":1790895979000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2837-0136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":26,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,10,1]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2837-0136","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3,19]]},"published":{"date-parts":[[2026,3,19]]}}}