Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction

Gabriel Levin*, Uriel Elchalal, Simcha Yagel, Smadar Eventov-Friedman, Yossef Ezra, Yishay Sompolinsky, David Mankuta, Amihai Rottenstreich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


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.

Original languageAmerican English
Pages (from-to)1464-1472
Number of pages9
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number11
StatePublished - 1 Nov 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Nordic Federation of Societies of Obstetrics and Gynecology


  • morbidity
  • operative vaginal delivery
  • outcomes
  • subgaleal hemorrhage
  • vacuum-assisted delivery


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