Neonatal complications in vacuum-assisted vaginal delivery: are they associated with number of pulls, cup detachments, and duration of vacuum application?
OBJECTIVE
To explore whether the characteristics of vacuum delivery are associated with the occurrence of head injury and neonatal complications.


METHODS
Retrospectively cohort study of vacuum-assisted attempted vaginal deliveries of singletons. We studied the association of total duration of vacuum application and number of pulls and cup dislodgement with (1) primary outcome: the occurrence of major (subgaleal hemorrhage, skull fracture, and intracranial hemorrhage) or minor (cephalohematoma, scalp laceration more extensive than simple abrasions) neonatal head injuries and (2) secondary outcome: the occurrence of neonatal complications, including 5-min Apgar score <7, umbilical artery pH < 7.10, shoulder dystocia, or need for neonatal intensive care unit admission. Logistic regression analysis was used to control for confounders.


RESULTS
Vacuum-assisted delivery was attempted in 555 women. It was successful in 515 cases, and it failed in 40 (7.2 %). Head injury occurred in 32 (6.2 %) of vaginally delivered neonates, and it was related to duration of vacuum application (P = 0.004) and birth weight (P = 0.048). However, the associations lost a statistical significance at the multivariate analysis. Neonatal complications occurred in 25 cases (5 %), and they were associated with meconium-stained amniotic fluid (P < 0.001) and duration of vacuum application (P = 0.03) at the multivariate analysis. However, most of the complications were actually associated with the need for vacuum delivery rather than the procedure itself.


CONCLUSIONS
Neonatal head injury after vacuum application is not independently related to total duration of vacuum application, number of pulls, or cup dislodgements.
Department of Obstetrics and Gynecology, Inova Alexandria Hospital, Alexandria, VA, USA. Alessandro.Ghidini@Inova.org.|Antenatal Testing Center, Inova Alexandria Hospital, 4320 Seminary Rd, Alexandria, VA, 22304, USA. Alessandro.Ghidini@Inova.org.
Alessandro
A
Ghidini
Department of Obstetrics and Gynecology, Inova Alexandria Hospital, Alexandria, VA, USA.
Daniel
D
Stewart
Department of Medicine, Georgetown University Medical Center, Washington, DC, USA.
John C
JC
Pezzullo
Department of Obstetrics and Gynecology, Vittorio Emanuele III Hospital, Carate, University of Milano-Bicocca, Milan, Italy.
Anna
A
Locatelli
D000328:Adult; D001720:Birth Injuries / Q000209:etiology*; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000209:etiology*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical / Q000009:adverse effects* / Q000379:methods*
Cephalohematoma; Neonatal complications; Operative vaginal delivery; Vacuum extraction