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

Abstract

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.

Neonatal and maternal outcome of small‐for‐gestational‐age neonates delivered by vacuum‐assisted delivery

“…19 Interestingly, a recent It is well established that VAD and parity are strongly associated with neonatal cranial trauma occurrence. 2,21 Therefore, we aimed to isolate the effect of parity on this adverse outcome and address only nulliparous women delivering by VAD. Other findings in our study cohort are not surprising.…”

Association between vacuum extraction and subgaleal haemorrhage: can intrapartum ultrasound reduce the risks?

“…SGH is a life-threatening condition caused by bleeding into the space between the galea aponeurosis and pericranium of the scalp (Figure 1). The loose areolar tissue that lies in this potential space can accommodate a large volume of blood; newborns with SGH can lose more than half of total blood volume and result in hypovolaemic shock, coagulopathy, anaemia, hyperbilirubinaemia, and death 6,9 . The incidence of SGH is estimated to be 0.4 per 1000 spontaneous vaginal deliveries and 5.9 per 1000 VE deliveries 10 , whereas 60% to 89% of SGH occur as a result of VE 7 .…”

“…Comparing babies with or without SGH after attempted VE, six independent risk factors have been identified: second-stage duration (for each 30-minute increase: adjusted odds ratio (aOR)=1.13, p=0.006), presence of meconium-stained amniotic fluid (aOR=2.61, p=0.001), presence of caput succedaneum (aOR=1.79, p=0.01), duration of VE (for each 3-minute increase: aOR=2.04, p<0.001), number of dislodgments (aOR=2.38, p<0.001), and fetal head station (aOR=3.57, p=0.006). VE duration of ≥15 minutes has 96.7% sensitivity and 75.0% specificity in predicting SGH, with the area under the receiver operating characteristic curve being 0.849 9 . Various factors that contribute to a difficult VE are associated with increased risks of SGH.…”

Das subgaleale Hämatom beim Neugeborenen – ein neonatologischer Notfall

“…Die Inzidenz des SGH liegt bei 0,2 - 3/1.000 Lebendgeburten 5 6 7 8 9 10 . Bekannte Risikofaktoren sind die Primigravidität 8 9 , eine lange Austreibungsphase 8 11 12 , die Geburt mittels Vakuumextraktion 6 7 8 11 12 13 14 15 oder Forceps 5 6 11 , Frühgeburtlichkeit 15 sowie eine Makrosomie 5 10 . Die Letalität liegt zwischen 2,7 und 22,8% 5 6 7 8 9 10 11 .…”

“…Bekannte Risikofaktoren sind die Primigravidität 8 9 , eine lange Austreibungsphase 8 11 12 , die Geburt mittels Vakuumextraktion 6 7 8 11 12 13 14 15 oder Forceps 5 6 11 , Frühgeburtlichkeit 15 sowie eine Makrosomie 5 10 . Die Letalität liegt zwischen 2,7 und 22,8% 5 6 7 8 9 10 11 . Die Behandlung umfasst die Therapie des hämorrhagischen Schocks sowie der Gerinnungsstörung.…”