Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction)

Ekéus, Cecilia; Wrangsell, Karin; S, Penttinen; Åberg, Katarina

doi:10.1080/14767058.2017.1344631

Cited by 34 publications

(21 citation statements)

References 16 publications

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“…[28][29][30][31] A cut-off of 15 minutes was advocated by some. 18,32 This is in line with our findings of VAD duration as independently associated with SGH formation, and of the cut-off of 15 minutes as highly predictive of SGH occurrence. Our finding of an independent association of the number of dislodgments with SGH formation is not surprising, as the occurrence of vacuum dislodgments is commonly believed to carry an increased risk for head injuries.…”

Section: Discussionsupporting

confidence: 88%

“…In an effort to ensure a safe delivery by VAD, various guidelines suggest a duration of VAD attempt of no more than 20 minutes . A cut‐off of 15 minutes was advocated by some . This is in line with our findings of VAD duration as independently associated with SGH formation, and of the cut‐off of 15 minutes as highly predictive of SGH occurrence.…”

Section: Discussionsupporting

confidence: 87%

“…Our finding of an independent association of the number of dislodgments with SGH formation is not surprising, as the occurrence of vacuum dislodgments is commonly believed to carry an increased risk for head injuries. Some authors found that the occurrence of any cup detachment is associated with increased neonatal trauma . Cup detachments during traction have been postulated to result in scalp lacerations and abrasions, and in the rupture and shearing of underlying blood vessels.…”

Section: Discussionmentioning

confidence: 99%

“…The strongest risk factor for SGH and other intracranial hemorrhage occurrence has been shown to be operative vaginal delivery, particularly VAD . However, current knowledge of factors associated with the development of SGH following VAD is primarily based on small studies . Given the paucity of literature, we aimed to evaluate the factors associated with SGH formation following attempted VAD.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6][9][10][11][12][13][14][15] However, current knowledge of factors associated with the development of SGH following VAD is primarily based on small studies. 10,[16][17][18] Given the paucity of literature, we aimed to evaluate the factors associated with SGH formation following attempted VAD.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Levin

Elchalal

Yagel

et al. 2019

Acta Obstet Gynecol Scand

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Levin

Elchalal

Yagel

et al. 2019

Acta Obstet Gynecol Scand

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Head position and vacuum‐assisted delivery using the Kiwi Omnicup

Schreiber

Cohen

Maor

et al. 2022

Intl J Gynecology & Obste

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Objective To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes. Method This retrospective cohort study included all vacuum‐assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third‐ or fourth‐degree perineal tear, pH < 7.1, and subgaleal hematoma (SGH). AGAR, neonatal intensive care unit admission, cephalohematoma, Erb's palsy, third‐stage duration, and postpartum hemorrhage were secondary. Outcomes were compared between the occiput posterior (OP) and occiput anterior (OA) positions. Results The study included 1960 patients. OP position was more likely to involve epidural analgesia (311 [82.5%] vs. 1216 [77%], P = 0.020), higher fetal head station (P = 0.001), higher percentage of cup detachments (121 cases [32.1%] vs. 307 [19.4%], P = 0.001), and longer procedure (5.5 ± 3.7 min vs. 4.7 ± 2.8 min, P = 0.001). OP was associated with umbilical cord pH < 7.1 (21 [5.5%] vs. 52 [3.9%], P = 0.032), NICU admissions (16 [4.2%] vs. 38 [2.4%], P = 0.049), SGH (18 [4.8%] vs. 38 [2.4%], P = 0.013), and high‐degree perineal tears (12 [3.2%] vs. 26 [1.7%], with borderline significance, P = 0.051). SGH and high‐grade tears remained significantly associated with OP position (P = 0.008 and P = 0.016, respectively) after adjusting for maternal age, nulliparity, diabetes, epidural anesthesia, preprocedure head station, and birth weight. Conclusion OP position is an independent risk‐factor for anal sphincter injury and SGH during vacuum‐assisted delivery.

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Iatrogenic Disease

Nikkels

2022

Keeling's Fetal and Neonatal Pathology

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Neonatal complications among 596 infants delivered by vacuum extraction (in relation to characteristics of the extraction)

Abstract: Extraction time >15 min, >6 pulls and >1 cup detachment is associated with increased risk of neonatal complications. These results support compliance with guidelines and recommendations for VE deliveries.

Cited by 34 publications

References 16 publications

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Head position and vacuum‐assisted delivery using the Kiwi Omnicup

Iatrogenic Disease

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