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
N1 - Publisher Copyright:
© 2019 Nordic Federation of Societies of Obstetrics and Gynecology
PY - 2019/11/1
Y1 - 2019/11/1
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.
AB - 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.
KW - morbidity
KW - operative vaginal delivery
KW - outcomes
KW - subgaleal hemorrhage
KW - vacuum-assisted delivery
UR - http://www.scopus.com/inward/record.url?scp=85070341477&partnerID=8YFLogxK
U2 - 10.1111/aogs.13678
DO - 10.1111/aogs.13678
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C2 - 31220332
AN - SCOPUS:85070341477
SN - 0001-6349
VL - 98
SP - 1464
EP - 1472
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 11
ER -