Vacuum assisted delivery--the need for caution.
In the United Kingdom and Republic of Ireland 10% of all deliveries are vacuum assisted. The vacuum is preferred over forceps because it is easier to perform and associated with less maternal morbidity. It is, however, also associated with subaponeurotic haemorrhage that has an incidence of 6.4 per 1000 vacuum assisted deliveries and a mortality of 23%. Based on a figure of 77,500 births annually in Ireland, North and South, it is possible that as many as 11 neonatal deaths each year may attributable to what is generally considered a safe obstetric intervention. In North America concerns about the safety of vacuum assisted delivery resulted in the issuing of public health advisories in both Canada and the United States. To date such concerns have not been raised in either the United Kingdom or Republic of Ireland. We report a case of fatal subaponeurotic haemorrhage to highlight and bring these concerns to the attention of obstetricians, paediatricians and midwives. We also call for the introduction of a national surveillance in order to assess the true extent of this potentially fatal complication.
Macleod
C
C
Department of Paediatrics, Antrim Area Hospital, 45 Bush Road, Antrim BT41 2RL, Northern Ireland. cmacleod@doctors.org.uk
O'Neill
C
C
D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*