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

OBJECTIVE

To investigate the association between complicated vacuum extraction (VE) deliveries and neonatal complications.

METHODS

Observational study including data on the management of 596 consecutive VE-deliveries at 6 different birth clinics in Sweden in 2013. We used logistic regression to examine the association between a complicated VE and: extracranial bleeding, severe neonatal complication (intracranial hemorrhage and/or asphyxia/low Apgar score and/or convulsions, and/or encephalopathy), and brachial plexus injury. VE was considered complicated if duration exceeded 15 min, and/or more than six pulls were used, and/or more than one cup detachment occurred. Uncomplicated VE served as the reference group.

RESULTS

Ten percent of the infants were diagnosed with at least one of the investigated complications. Cephalohematoma occurred in 5.2% of the infants and 1.5% had a subgaleal hematoma. Altogether 24 (4.0%) infants were diagnosed with a severe complication; low Apgar score, neonatal convulsions, encephalopathy or intracranial hemorrhages. Brachial plexus injury occurred in eight (1.3%) infants. The crude odds ratio for extracranial hemorrhages was 2.6 (95% CI 1.17-5.77), 4.07 (1.67-9.92) for severe neonatal complications, and 4.63 (1.08-19.76) for brachial plexus injury.

CONCLUSIONS

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.