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Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction.
Acta Obstet Gynecol Scand. 2019 11; 98(11):1464-1472.AO

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.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31220332

Citation

Levin, Gabriel, et al. "Risk Factors Associated With Subgaleal Hemorrhage in Neonates Exposed to Vacuum Extraction." Acta Obstetricia Et Gynecologica Scandinavica, vol. 98, no. 11, 2019, pp. 1464-1472.
Levin G, Elchalal U, Yagel S, et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand. 2019;98(11):1464-1472.
Levin, G., Elchalal, U., Yagel, S., Eventov-Friedman, S., Ezra, Y., Sompolinsky, Y., Mankuta, D., & Rottenstreich, A. (2019). Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstetricia Et Gynecologica Scandinavica, 98(11), 1464-1472. https://doi.org/10.1111/aogs.13678
Levin G, et al. Risk Factors Associated With Subgaleal Hemorrhage in Neonates Exposed to Vacuum Extraction. Acta Obstet Gynecol Scand. 2019;98(11):1464-1472. PubMed PMID: 31220332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. AU - Levin,Gabriel, AU - Elchalal,Uriel, AU - Yagel,Simcha, AU - Eventov-Friedman,Smadar, AU - Ezra,Yossef, AU - Sompolinsky,Yishay, AU - Mankuta,David, AU - Rottenstreich,Amihai, Y1 - 2019/07/26/ PY - 2019/03/21/received PY - 2019/06/14/accepted PY - 2019/6/21/pubmed PY - 2020/4/1/medline PY - 2019/6/21/entrez KW - morbidity KW - operative vaginal delivery KW - outcomes KW - subgaleal hemorrhage KW - vacuum-assisted delivery SP - 1464 EP - 1472 JF - Acta obstetricia et gynecologica Scandinavica JO - Acta Obstet Gynecol Scand VL - 98 IS - 11 N2 - 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. SN - 1600-0412 UR - https://www.unboundmedicine.com/medline/citation/31220332/Risk_factors_associated_with_subgaleal_hemorrhage_in_neonates_exposed_to_vacuum_extraction L2 - https://doi.org/10.1111/aogs.13678 DB - PRIME DP - Unbound Medicine ER -