title: Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction.
abstract: OBJECTIVE
  To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital.
  
  
  METHODS
  All infants born in the hospital with a history of exposure to vacuum extraction.
  
  
  METHODS
  A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life.
  
  
  METHODS
  A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants.
  
  
  RESULTS
  Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0).
  
  
  CONCLUSIONS
  Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.
authors.affiliation: Department of Paediatrics, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia.
authors.forename: Nem-Yun
authors.initials: NY
authors.lastname: Boo
authors.forename: Kin-Wai
authors.initials: KW
authors.lastname: Foong
authors.forename: Zaleha Abdullah
authors.initials: ZA
authors.lastname: Mahdy
authors.forename: Sin-Chuen
authors.initials: SC
authors.lastname: Yong
authors.forename: Rohana
authors.initials: R
authors.lastname: Jaafar
mesh_terms: D000328:Adult; D001034:Apgar Score; D001720:Birth Injuries / Q000209:etiology*; D006259:Craniocerebral Trauma / Q000209:etiology*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012535:Scalp / Q000293:injuries*; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects*