Introduction Subgaleal hemorrhage (SGH) is a life‐threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well‐established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD. Material and methods A retrospective case‐control study of women who delivered at a tertiary university‐affiliated medical center in Jerusalem, Israel, during 2009‐2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one‐to‐one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups. Results In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second‐stage duration (for each 30‐minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04‐1.25; P = .006), presence of meconium‐stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52‐4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11‐2.88; P = .01), duration of VAD (for each 3‐minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66‐3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42‐8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849. Conclusions Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.

Objective To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour. Design Retrospective Electronic‐Medical‐Record (EMR) ‐based study. Population A cohort of 73 868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO. Methods A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high‐risk and low‐risk groups based on the Youden index to maximise sensitivity and specificity. Main outcome measures SANO was defined as either umbilical cord pH levels ≤7.1 or 1‐minute or 5‐minute Apgar score ≤7. Results The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748–0.774). A third of the cohort (33.5%, n = 24 721) were allocated to a high‐risk group for SANO, which captured up to 72.1% of these cases (odds ratio 5.3, 95% CI 4.7–6.0; high‐risk versus low‐risk groups). Conclusions Data acquired throughout the first stage of labour can be used to predict SANO during the second stage of labour using a machine learning model. Stratifying parturients at the beginning of the second stage of labour in a ‘time out’ session, can direct a personalised approach to management of this challenging aspect of labour, as well as improve allocation of staff and resources. Tweetable abstract Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model.

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Objectives: To determine the risk of spontaneous preterm birth (sPTB) associated with the length of second stage of labour in the first term delivery. Design: Retrospective cohort study. Setting: University hospital. Population: Women with first two consecutive singleton births and the first birth at term. Those who did not reach the second stage of labour in the first delivery were excluded. Methods: Charts from 2007 to 2019 were reviewed. Main outcome measures: Rate of sPTB (<37 weeks of gestation) in the second delivery.Results: Of 13 958 women who met study inclusion criteria, 1464 (10.5%) parturients had a prolonged second stage (≥180 min) in their first term delivery. The rate of sPTB in the second delivery was similar in those with and without a prolonged second stage in first delivery (2.8% versus 2.8%; adjusted odds ratio [aOR] 1.35, 95% CI 0.96-1.90). After adjustment for mode of delivery, prolonged second stage was also not associated with subsequent sPTB in those who delivered by spontaneous and operative vaginal delivery. Those delivered by second-stage caesarean section in the first delivery had a higher risk of sPTB in the second delivery (25/526, 4.8%; aOR 2.66, 95% CI 1.71-4.12; p < 0.001), with a more pronounced risk in those with secondstage caesarean following a prolonged second stage of labour (15/259, 5.8%; aOR 3.40, 95% CI 1.94-5.94; p < 0.001). Conclusion:Second-stage duration in a first term vaginal delivery is not associated with subsequent sPTB. The risk of sPTB is increased following second-stage caesarean section, particularly if performed after a prolonged second stage.