1
|
Kong CW, To WWK. Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates. Arch Gynecol Obstet 2024; 309:1411-1419. [PMID: 37017783 DOI: 10.1007/s00404-023-07018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. METHODS All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. RESULTS The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). CONCLUSION Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.
Collapse
Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China.
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China
| |
Collapse
|
2
|
Schreiber H, Cohen G, Shechter Maor G, Haikin Herzberger E, Biron-Shental T, Markovitch O. Head position and vacuum-assisted delivery using the Kiwi Omnicup. Int J Gynaecol Obstet 2023; 160:836-841. [PMID: 35869967 DOI: 10.1002/ijgo.14367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes. METHOD This retrospective cohort study included all vacuum-assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third- or fourth-degree perineal tear, pH < 7.1, and subgaleal hematoma (SGH). AGAR, neonatal intensive care unit admission, cephalohematoma, Erb's palsy, third-stage duration, and postpartum hemorrhage were secondary. Outcomes were compared between the occiput posterior (OP) and occiput anterior (OA) positions. RESULTS The study included 1960 patients. OP position was more likely to involve epidural analgesia (311 [82.5%] vs. 1216 [77%], P = 0.020), higher fetal head station (P = 0.001), higher percentage of cup detachments (121 cases [32.1%] vs. 307 [19.4%], P = 0.001), and longer procedure (5.5 ± 3.7 min vs. 4.7 ± 2.8 min, P = 0.001). OP was associated with umbilical cord pH < 7.1 (21 [5.5%] vs. 52 [3.9%], P = 0.032), NICU admissions (16 [4.2%] vs. 38 [2.4%], P = 0.049), SGH (18 [4.8%] vs. 38 [2.4%], P = 0.013), and high-degree perineal tears (12 [3.2%] vs. 26 [1.7%], with borderline significance, P = 0.051). SGH and high-grade tears remained significantly associated with OP position (P = 0.008 and P = 0.016, respectively) after adjusting for maternal age, nulliparity, diabetes, epidural anesthesia, preprocedure head station, and birth weight. CONCLUSION OP position is an independent risk-factor for anal sphincter injury and SGH during vacuum-assisted delivery.
Collapse
Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shechter Maor
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Haikin Herzberger
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Yim SLY, Petersen TW, Uppal MT, Quinlivan JA. Compliance with clinical guidelines increases the safety of vacuum-assisted delivery. Aust N Z J Obstet Gynaecol 2023; 63:13-18. [PMID: 35587573 DOI: 10.1111/ajo.13545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. AIM The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. MATERIALS AND METHODS Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. RESULTS There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P = 0.0002), major birth trauma (3% vs 22%, P = 0.0001), requirement for neonatal resuscitation (14% vs 35%, P = 0.0026) and Apgar scores at one minute less than six (5% vs 22% P = 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P = 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P = 0.02) and birth requiring instrument change (4% vs 13% P = 0.031). CONCLUSION Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.
Collapse
Affiliation(s)
- Stephen L Y Yim
- Northern Beaches Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia
| | - Tomas W Petersen
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Munawwara Talat Uppal
- Northern Beaches Hospital Department of Obstetrics and Gynaecology, Sydney, New South Wales, Australia.,School of Medicine, Sydney University, Sydney, New South Wales, Australia
| | - Julie A Quinlivan
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia.,School of Medicine, Australia National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
4
|
Neonatal subgaleal hemorrhage: twenty years of trends in incidence, associations, and outcomes. J Perinatol 2022; 43:573-577. [PMID: 36307481 DOI: 10.1038/s41372-022-01541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2011, we reported 38 neonates with subgaleal hemorrhage (SH), relating an increasing incidence. It is unclear whether the incidence in our hospitals continued to rise and which risk factors and outcomes are associated with this condition. DESIGN We retrospectively analyzed every recognized case of SH in our hospitals from the end of our previous report (2010) to the present (2022). We redescribed the incidence, scored severity, tabulated blood products transfused, and recorded outcomes. RESULTS Across 141 months, 191 neonates were diagnosed with SH; 30 after vacuum or forceps. The incidence (one/1815 births) was higher than in our 2011 report (one/7124 births). Also, severe SH (requiring transfusion) was more common (one/10,033 births vs. one/20,950 births previously). Four died (all with severe SH) and 12 had neurodevelopmental impairment. CONCLUSION Recognized cases of SH are increasing in our system without a clear explanation. Adverse outcomes are rare but continue to occur.
Collapse
|
5
|
Prediction of neonatal subgaleal hemorrhage using first stage of labor data: a machine-learning based model. J Gynecol Obstet Hum Reprod 2022; 51:102320. [DOI: 10.1016/j.jogoh.2022.102320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
|
6
|
Levin G, Rosenbloom JI, Sultani M, Meyer R, Porat S, Ofek-Shlomai N, Yagel S, Rottenstreich A. The role of sonographic head circumference in the occurrence of subgaleal hemorrhage following vacuum delivery. J Matern Fetal Neonatal Med 2021; 35:5450-5455. [PMID: 33535839 DOI: 10.1080/14767058.2021.1882983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Subgaleal hemorrhage (SGH) is a severe neonatal morbidity that is associated with vacuum-assisted delivery (VAD). Large sonographic head circumference (sHC) was previously associated with complicated VAD. Nevertheless, the association of large sHC with SGH formation following VAD is underreported. We aim to evaluate the role of sonographic head circumference (sHC) with SGH formation following attempted VAD. METHODS A retrospective case-control study. Cases comprised singleton pregnancies for whom attempted VAD resulted in SGH with an sHC measured within 2 weeks from delivery. Controls were VAD deliveries which not resulted in SGH, with an sHC measured within 2 weeks from delivery. We matched controls in a 1:1 ratio by gestational age, parity and year of delivery. RESULTS Overall, 118 women were included in the SGH study group and were matched to 118 controls. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birth weight in the SGH group (median 3422 vs. 3195 grams, p = .001). sHC did not vary between groups (median 336 mm in SGH groups vs. 333, p = .08). Rate of sHC >90th and >95th percentile did not significantly differ between the groups (13.6% vs. 8.5%, 6.8% vs. 3.4%, p = .21, p = .37, for SGH vs. controls, respectively). In multivariate regression analysis, sHC was not found to be independently associated with SGH - aOR (95% CI) 1.004 (0.97-1.03). Receiver operating characteristic curves of sHC for SGH formation underlined an area under the curve of 0.58 (95% CI) (0.51-0.65). CONCLUSIONS sHC is not associated with SGH formation following VAD.
Collapse
Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek-Shlomai
- Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
7
|
Phipps H, Hyett JA, Kuah S, Pardey J, Matthews G, Ludlow J, Narayan R, Santiagu S, Earl R, Wilkinson C, Bisits A, Carseldine W, Tooher J, McGeechan K, de Vries B. Persistent occiput posterior position outcomes following manual rotation: a randomized controlled trial. Am J Obstet Gynecol MFM 2021; 3:100306. [PMID: 33418103 DOI: 10.1016/j.ajogmf.2021.100306] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Persistent occiput posterior position in labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation from the occiput posterior position to the occiput anterior position in the second stage of labor is considered a safe and easy to perform procedure that in observational studies has shown promise as a method for preventing operative deliveries. OBJECTIVE This study aimed to determine the efficacy of prophylactic manual rotation in the management of occiput posterior position for preventing operative delivery. The hypothesis was that among women who are at least 37 weeks pregnant and whose baby is in the occiput posterior position early in the second stage of labor, manual rotation will reduce the rate of operative delivery compared with the "sham" rotation. STUDY DESIGN A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 4 tertiary hospitals was conducted in Australia. A total of 254 nulliparous and parous women with a term pregnancy and a baby in the occiput posterior position in the second stage of labor were randomly assigned to receive either a prophylactic manual rotation (n=127) or a sham rotation (n=127). The primary outcome was operative delivery (cesarean, forceps, or vacuum delivery). Secondary outcomes were cesarean delivery, combined maternal mortality and serious morbidity, and combined perinatal mortality and serious morbidity. Analysis was by intention to treat. Proportions were compared using chi-square tests adjusted for stratification variables using the Mantel-Haenszel method or the Fisher exact test. Planned subgroup analyses by operator experience and by manual rotation technique (digital or whole-hand rotation) were performed. RESULTS Operative delivery occurred in 79 of 127 women (62%) assigned to prophylactic manual rotation and 90 of 127 women (71%) assigned to sham rotation (common risk difference, 12; 95% confidence interval, -1.7 to 26; P=.09). Among more experienced operators or investigators, operative delivery occurred in 46 of 74 women (62%) assigned to manual rotation and 52 of 71 women (73%) assigned to a sham rotation (common risk difference, 18; 95% confidence interval, -0.5 to 36; P=.07). Cesarean delivery occurred in 22 of 127 women (17%) in both groups. Instrumental delivery (forceps or vacuum) occurred in 57 of 127 women (45%) assigned to prophylactic manual rotation and 68 of 127 women (54%) assigned to sham rotation (common risk difference, 10; 95% confidence interval, -3.1 to 22; P=.14). There was no significant difference in the combined maternal and perinatal outcomes. CONCLUSION Prophylactic manual rotation did not result in a reduction in the rate of operative delivery. Given manual rotation was associated with a nonsignificant reduction in operative delivery, more randomized trials are needed, as our trial might have been underpowered. In addition, further research is required to further explore the potential impact of operator or investigator experience.
Collapse
Affiliation(s)
- Hala Phipps
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia.
| | - Jon A Hyett
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sabrina Kuah
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - John Pardey
- Nepean Hospital, Penrith, New South Wales, Australia
| | - Geoff Matthews
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Joanne Ludlow
- Discipline of Obstetrics, Gynaecology and Neonatology, The University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Ultrasound Care, Sydney, New South Wales, Australia
| | - Rajit Narayan
- Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Stanley Santiagu
- Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rachel Earl
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Chris Wilkinson
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Andrew Bisits
- Royal Hospital for Women, Sydney, New South Wales, Australia; Discipline of Obstetrics, Gynaecology and Neonatology, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Carseldine
- Maternity and Gynaecology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jane Tooher
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Royal Prince Alfred Hospital Women and Babies Ambulatory Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Bradley de Vries
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| |
Collapse
|
8
|
Goordyal D, Anderson J, Alazmani A, Culmer P. An engineering perspective of vacuum assisted delivery devices in obstetrics: A review. Proc Inst Mech Eng H 2021; 235:3-16. [PMID: 32928047 PMCID: PMC7780266 DOI: 10.1177/0954411920956467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
Complications during childbirth result in the need for clinicians to use 'assisted delivery' in over 12% of cases (UK). After more than 50 years in clinical practice, vacuum assisted delivery (VAD) devices remain a mainstay in physically assisting child delivery; sometimes preferred over forceps due to their ease of use and reduced maternal morbidity. Despite their popularity and enduring track-record, VAD devices have shown little evidence of innovation or design change since their inception. In addition, evidence on the safety and functionality of VAD devices remains limited but does present opportunities for improvements to reduce adverse clinical outcomes. Consequently in this review we examine the literature and patent landscape surrounding VAD biomechanics, design evolution and performance from an engineering perspective, aiming to collate the limited but valuable information from a disparate field and provide a series of recommendations to inform future research into improved, safer, VAD systems.
Collapse
Affiliation(s)
- Dushyant Goordyal
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
| | - John Anderson
- Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, West Yorkshire, UK
| | - Ali Alazmani
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
| | - Peter Culmer
- University of Leeds Faculty of
Engineering, Mechanical Engineering, Leeds, West Yorkshire, UK
| |
Collapse
|
9
|
Levin G, Mankuta D, Eventov-Friedman S, Ezra Y, Koren A, Yagel S, Rottenstreich A. Factors associated with the severity of neonatal subgaleal haemorrhage following vacuum assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 245:205-209. [DOI: 10.1016/j.ejogrb.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022]
|
10
|
Abstract
Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.
Collapse
Affiliation(s)
- Tiffany McKee-Garrett
- Baylor College of Medicine, Department of Pediatrics, Section of Neonatology, Houston, TX, USA.
| |
Collapse
|
11
|
Neonatal subgaleal hemorrhage unrelated to assisted vaginal delivery: clinical course and outcomes. Arch Gynecol Obstet 2019; 301:93-99. [PMID: 31768745 DOI: 10.1007/s00404-019-05392-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the occurrence of subgaleal hemorrhage (SGH) following non-assisted vaginal delivery (normal vaginal delivery or cesarean delivery), and to characterize associated factors, clinical course, and outcomes, compared to attempted assisted vaginal delivery (AVD)-associated SGH METHODS: A retrospective cohort study was conducted. All cases of SGH encountered following delivery of a singleton neonate at Hadassah, Hebrew University Medical Center during 2011-2018 were included. Maternal, fetal, intrapartum, and neonatal characteristics and outcomes were compared between AVD-related and non-AVD-related SGH groups. RESULTS The overall incidence of SGH was 4.5/1000 (369/82,256) singleton deliveries. The incidences of AVD- and non-AVD-related SGH were 44.6/1000 (350/7852) and 0.3/1000 (19/74,404) singleton deliveries, respectively. Ten (53%) of the 19 non-AVD-related SGH were diagnosed after vaginal delivery and 9 (47%) after an urgent cesarean section. SGH severity was mild, moderate, and severe in 68%, 16%, and 16% of the cases, respectively. SGH severity did not differ between the attempted AVD group and the non-AVD-related SGH group. A higher proportion of neonates with non-AVD SGH required phototherapy treatment than did those diagnosed with AVD-related SGH (56% vs. 24%, P = 0.003). Other neonatal outcomes, including Apgar scores, maximal bilirubin level, length of stay, and the rate of composite adverse outcomes, did not differ between the groups. CONCLUSIONS SGH, although rare, may be diagnosed after unassisted vaginal or cesarean delivery in the absence of an AVD attempt. We advocate continuing education for all medical staff who participate in peripartum and neonatal care, regarding the possible occurrence of non-AVD-related SGH.
Collapse
|
12
|
Encephalopathy in neonates with subgaleal hemorrhage is a key predictor of outcome. Pediatr Res 2019; 86:234-241. [PMID: 30999320 DOI: 10.1038/s41390-019-0400-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Subgaleal hemorrhage (SGH) is reported to be associated with severe hemodynamic instability, coagulopathy, and even mortality. The importance of the presence or absence of neonatal encephalopathy in predicting SGH outcomes has not been explored. The aim of this study was to determine the relationship of clinical encephalopathy to short-term outcomes in neonates with SGH. METHODS Neonates ≥35 weeks gestation, diagnosed radiologically with SGH between 2010 and 2017, were included. Cases were divided into encephalopathic and non-encephalopathic. Demographic, clinical, and outcome data were compared between groups. RESULTS Of 54,048 live births, 56 had SGH, of them 13 (23%) had encephalopathy. When compared to the non-encephalopathic neonates, encephalopathic neonates had lower Apgar scores, lower hemoglobin, lower platelet count, longer neonatal intensive care unit stay, two (15%) deaths, and four (31%) required blood transfusion. No non-encephalopathic infant with SGH died or required blood transfusion. Notably, on magnetic resonance imaging (MRI), a majority of subgaleal collections had either no or minimal blood products. CONCLUSIONS In the absence of encephalopathy, SGH is not associated with adverse short-term outcome. Neurological assessment is likely to identify infants at higher risk for adverse outcome. The absence of MRI signal consistent with blood in subgaleal collection warrants further research.
Collapse
|
13
|
Levin G, Elchalal U, Yagel S, Eventov-Friedman S, Ezra Y, Sompolinsky Y, Mankuta D, Rottenstreich A. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019; 98:1464-1472. [PMID: 31220332 DOI: 10.1111/aogs.13678] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
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.
Collapse
Affiliation(s)
- Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Simcha Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yishay Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Mankuta
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
14
|
Miller ES, Lai Y, Bailit J, Reddy UM, Wapner RJ, Varner MW, Thorp JM, Leveno KJ, Caritis SN, Prasad M, Tita ATN, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE. Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes. Am J Perinatol 2019; 37:503-510. [PMID: 30895577 PMCID: PMC6754310 DOI: 10.1055/s-0039-1683439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes. STUDY DESIGN This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls. RESULTS Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application. CONCLUSION The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls.
Collapse
Affiliation(s)
- Emily S. Miller
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Yinglei Lai
- Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Jennifer Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Uma M. Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Ronald J. Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michael W. Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth J. Leveno
- Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Steve N. Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mona Prasad
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - George R. Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Dwight J. Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Sean C. Blackwell
- Department of Obstetrics and Gynecology, Children’s Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Jorge E. Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | | |
Collapse
|
15
|
Lee SJ, Kim JK, Kim SJ. The clinical characteristics and prognosis of subgaleal hemorrhage in newborn. KOREAN JOURNAL OF PEDIATRICS 2018; 61:387-391. [PMID: 30304906 PMCID: PMC6313086 DOI: 10.3345/kjp.2018.06800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/03/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. METHODS We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. RESULTS Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was 9.7±6.9 days. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH<7.0). Intracranial lesions associated with SGH were observed in 15 neonates (75%), including subdural hemorrhage (50%), subarachnoid hemorrhage (15%), intraventricular hemorrhage (5%), cerebral infarct (15%), skull fracture (30%), and cephalohematoma (20%). Twelve neonates (60%) required transfusion, 5 (25%) had seizures, and 3 (15%) died. Eight neonates (40%) had hyperbilirubinemia (mean total bilirubin, 13.1±7.4). The mean follow-up period was 8.4±7.5 months. At follow-up, 10 neonates (58.8%) were healthy with normal development, whereas 7 (41.2%) had neurological deficits. CONCLUSION The morbidity rate was 41.2% due to severe metabolic acidosis. Anemia, hyperbilirubinemia, low Apgar scores, and subdural hemorrhage did not affect the prognosis. The long-term outcomes of neonates with SGH are generally good. Only arterial blood pH was significantly associated with death.
Collapse
Affiliation(s)
- Sun Jin Lee
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University, Jeonju, Korea
| | - Sun Jun Kim
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University, Jeonju, Korea
| |
Collapse
|
16
|
Pettersson K, Yousaf K, Ranstam J, Westgren M, Ajne G. Predictive value of traction force measurement in vacuum extraction: Development of a multivariate prognostic model. PLoS One 2017; 12:e0171938. [PMID: 28257459 PMCID: PMC5336195 DOI: 10.1371/journal.pone.0171938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/29/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To enable early prediction of strong traction force vacuum extraction. DESIGN Observational cohort. SETTING Karolinska University Hospital delivery ward, tertiary unit. POPULATION AND SAMPLE SIZE Term mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277. METHODS Traction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction. STATISTICAL ANALYSIS A logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables. PREDICTORS Total (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull. OUTCOME Subjectively categorized extraction as strong versus non-strong. RESULTS The prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89. CONCLUSION Traction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
Collapse
Affiliation(s)
- Kristina Pettersson
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Khurram Yousaf
- Clintec, Karolinska Institute, Stockholm, Sweden
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Jonas Ranstam
- Statistician, Swedish Patient Insurance, Stockholm, Sweden
| | - Magnus Westgren
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
17
|
Colditz MJ, Lai MM, Cartwright DW, Colditz PB. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health 2015; 51:140-6. [PMID: 25109786 DOI: 10.1111/jpc.12698] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
Subgaleal haemorrhage (SGH) is an important cause of preventable morbidity and mortality in the neonate. Its increased prevalence in recent years has coincided with the rise in the number of births assisted by vacuum extraction. Three deaths in Australia within the last 7 years have been the subject of two coronial inquests. Subsequent coronial reports have highlighted that neonatal death from SGH can be prevented if appropriate attention is paid to identification of risk factors, early diagnosis, close observation and aggressive treatment. To prevent unnecessary deaths, all involved in the care of the baby after birth need to be aware of the importance of prompt diagnosis, monitoring and early treatment of SGH.
Collapse
Affiliation(s)
- Michael J Colditz
- Perinatal Research Centre, The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia
| | | | | | | |
Collapse
|
18
|
Linder N, Linder I, Fridman E, Kouadio F, Lubin D, Merlob P, Yogev Y, Melamed N. Birth trauma--risk factors and short-term neonatal outcome. J Matern Fetal Neonatal Med 2013; 26:1491-5. [PMID: 23560503 DOI: 10.3109/14767058.2013.789850] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The ability to predict birth trauma (BT) based on the currently recognized risk factors is limited and there is little information regarding the short-term neonatal outcome following BT. We aimed to identify risk factors for BT and to evaluate the effect of BT on short-term neonatal outcome. METHODS A retrospective, cohort, case-control study of all cases of BT in a single tertiary center (1986-2009). The control group included the two subsequent full-term singleton neonates who did not experienced BT. Short-term neonatal outcome was compared between the groups including Apgar scores, NICU admission, duration of hospitalization and neurologic, respiratory and metabolic morbidity. RESULTS Of the 118 280 singleton full-term newborns delivered during the study period, 2874 were diagnosed with BT (24.3/1000). The most frequent types of BT were scalp injuries (63.9%, 15.5/1000) and clavicular fracture (32.1%, 7.7/1000). The following factors were found to be independent risk factors for BT: instrumental delivery (OR 7.5, 95% CI 6.3-8.9), birth weight, delivery during risk hours, parity, maternal age and neonatal head circumference. Cesarean delivery was the only factor protective of BT (OR 0.2, 95% CI 0.2-0.3). Neonates in the study group had a prolonged length of hospital stay (3.3 versus 2.7 d, p = 0.001), were more likely to be admitted to the NICU (3.9% versus 1.9%, p < 0.001), and had a higher rate of jaundice (11.9% versus 7.1%, p < 0.001) and neurological morbidity (4.7% versus 2.3%, p < 0.001). CONCLUSION Instrumental delivery appears to be responsible for most cases of neonatal BT.
Collapse
|
19
|
|
20
|
Haikin EH, Mankuta D. Vacuum cup placement during delivery--a suggested obstetric quality assessment measure. J Matern Fetal Neonatal Med 2012; 25:2135-7. [PMID: 22533712 DOI: 10.3109/14767058.2012.684163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To establish standards for the deviation of vacuum cup placement from the ideal location during operative delivery in an academic center. METHODS Data on 92 vacuum deliveries were prospectively obtained. The actual point on the newborns head was determined and both midline and anterior-posterior line deviations from the ideal point of placement were calculated. RESULTS The most common indication for vacuum extraction was a nonreassuring fetal heart rate (66.7%). The average deviation on the mid anterior-posterior line was 3.72 ± 1.46 cm; the average midline-lateral deviation was 1.92 ± 1.33 cm. There was no statistically significant difference in the cup placement deviations between deliveries performed by residents and consultants. The vacuum procedure failed in 8.6% of the cases. CONCLUSIONS Accurate placement of the vacuum cup on the fetal head is considered to be clinically important. This assumption requires scientific clinical proof. Our local standard for deviation was established and will serve for audit. If safer neonatal and maternal outcomes are demonstrated, the deviation from the ideal placement location ought to become a universal quality measure for vacuum deliveries.
Collapse
Affiliation(s)
- Einat Herzberger Haikin
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel
| | | |
Collapse
|
21
|
Swanson AE, Veldman A, Wallace EM, Malhotra A. Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand 2011; 91:260-3. [PMID: 21995823 DOI: 10.1111/j.1600-0412.2011.01300.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subgaleal hemorrhage in the newborn is a serious adverse event that is often unrecognized and under-appreciated. This retrospective case series aimed to determine perinatal factors associated with subgaleal hemorrhage and subsequent neonatal outcomes. Obstetric and neonatal details of 21 infants with subgaleal hemorrhage over a 10-year period were collected. The mother was primiparous in 95% cases, 48% had a prolonged second stage (>120 minutes) and 43% had prolonged rupture of membranes (>12 hours). Thirteen infants (62%) were born by instrumental vaginal delivery. Ten infants (48%) required resuscitation at delivery. The severity of subgaleal hemorrhage was mild in four infants (19%), moderate in 10 (48%) and severe in seven (33%). Hypovolemic shock developed in 10 infants (48%), encephalopathy in 13 (62%) and coagulopathy was present in five infants (24%). There were three (14%) deaths. Long-term outcomes were good in the surviving infants.
Collapse
Affiliation(s)
- Amy E Swanson
- Department of Neonatology, Monash Medical Centre, Melbourne, Australia
| | | | | | | |
Collapse
|
22
|
Abstract
In this paper, the author presents 2 cases of sagittal synostosis with scaphocephaly that featured ossified scalp hematomas straddling the sagittal suture in the midparietal region. These ossified lesions were originally cephalohematomas. Collection of blood under the pericranium across the midline was possible in these cases because sagittal synostosis had obliterated the sagittal suture and its dense attachment to overlying periosteum. Scaphocephaly very likely exacerbated the difficulty of the deliveries and contributed to the causation of the scalp hemorrhages. The alternative hypothesis, that ossification of a scalp hematoma immobilized the suture and caused synostosis, is not tenable for reasons that are reviewed. Sagittal synostosis in these 2 instances was not a complication of birth trauma.
Collapse
Affiliation(s)
- Joseph H Piatt
- Section of Neurosurgery, Department of Pediatrics, Drexel University College of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
23
|
MOLA GD, KUK JM. A randomised controlled trial of two instruments for vacuum-assisted delivery (Vacca Re-Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness. Aust N Z J Obstet Gynaecol 2010; 50:246-52. [DOI: 10.1111/j.1479-828x.2010.01166.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
|
25
|
Bothuyne-Queste E, Deruelle P, Closset E, Depret S, Subtil D. [Comparative study of two single-use vacuum extractor]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2009; 38:149-154. [PMID: 19095377 DOI: 10.1016/j.jgyn.2008.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 04/04/2007] [Accepted: 05/30/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare the effectiveness of two single-use vacuum devices, the Kiwi Omnicup and the Mitysoft Bell. MATERIAL AND METHODS This retrospective study was conducted during two different periods: from January 15th to March 14th to assess the Kiwi Omnicup and from March 15th to June 15th for the Mitysoft Bell. The primary outcome was the successful completion of delivery with the allocated instrument. Secondary outcomes were fetal scalp trauma and maternal perineal lesions. All deliveries were performed by similar teams. RESULTS Thirty-nine patients were included in the Kiwi Omnicup group and 48 in the Mitysoft Bell group. Compared to the Kiwi Omnicup, the Mitysoft Bell was associated with a greater number of cup detachments (41.7% vs. 10.3%; p<0.01) and a significantly higher rate of failure (31.3% vs. 12.8%). Rates of substantial scalp trauma and maternal trauma were similar in both groups. CONCLUSION The Mitysoft Bell is not as successful at achieving a vaginal delivery as the Kiwi Omnicup. This could be explained by the shape of the cup.
Collapse
Affiliation(s)
- E Bothuyne-Queste
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | | | | | | | | |
Collapse
|
26
|
|
27
|
Ismail NAM, Saharan WSL, Zaleha MA, Jaafar R, Muhammad JA, Razi ZRM. Kiwi Omnicup versus Malmstrom metal cup in vacuum assisted delivery: a randomized comparative trial. J Obstet Gynaecol Res 2008; 34:350-3. [PMID: 18686348 DOI: 10.1111/j.1447-0756.2007.00701.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the success, clinical outcomes, and maternal and neonatal complications between the Kiwi Omnicup and the Malmstrom metal cup in vacuum assisted delivery. METHODS This was a prospective randomized comparative trial. Women who required vacuum assisted vaginal delivery were randomized into the Kiwi Omnicup (KO) group and the Malmstrom metal cup (MM) group. The vacuum assisted deliveries were conducted according to hospital protocol. Details of the procedure and delivery outcomes including success and complications were analyzed. RESULTS One hundred and sixty-four women were recruited - 85 were assigned to vacuum assisted delivery using the KO and 79 the MM. One hundred percent delivery success was achieved with no significant differences between the two instruments in terms of maternal morbidity (P = 0.66). Six women in the MM group sustained post delivery complications in comparison to five in the KO group. Three babies were diagnosed with birth asphyxia in each group. More babies in the MM group were admitted to the Neonatal Intensive Care Unit (NICU) (10 babies versus 5 babies) and suffered complications (14 versus 12 babies), compared to the KO group, although the difference was not statistically significant. There were no intrapartum or neonatal deaths and of those admitted to the NICU, all were discharged within a week without any serious consequences. CONCLUSION Kiwi Omnicup is an effective alternative to the currently available Malmstrom metal cup for vacuum assisted delivery with no increase in maternal or neonatal morbidity or mortality.
Collapse
Affiliation(s)
- Nor Azlin M Ismail
- Department of Obstetrics & Gynecology, University Kebangsaan Malaysia, Jalan Yaacob Latiff, Kuala Lumpur, Malaysia.
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Instrumental vaginal delivery involves the use of the vacuum extractor or obstetric forceps to facilitate delivery of the fetus. It is associated with substantial risk of head injury, including hemorrhage, fractures, and, rarely, brain damage or fetal death. This review article describes the different types, etiology, pathophysiology, risk factors, and clinical features of head trauma after instrumental birth, along with their management and prevention strategies.
Collapse
Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St. George's University of London, Cranmer Terrace, London SW17 0RE, UK.
| | | |
Collapse
|
29
|
Subgaleal hemorrhage with dural tear and parietal-lobe herniation in association with a vacuum extraction. J Perinatol 2007; 27:797-9. [PMID: 18034165 DOI: 10.1038/sj.jp.7211845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Use of the vacuum for operative vaginal deliveries has become more favorable with fewer obstetricians and family practitioners trained in the use of forceps. When compared with forcep-assisted deliveries, the vacuum has been associated with a higher incidence of subgaleal hemorrhage (SGH), cephalhematomas, skull and clavicular fractures, Erb's Palsy, intracranial hemorrhage and need for ICN admission. We report the case of an infant who developed a large SGH with midline dural tear and herniation of the medial aspect of the parietal lobes bilaterally in association with a vacuum extraction (VE) delivery. Counseling of families prior to instrumented delivery as to the potential complications, adherence to recommendations for abandoning operative vaginal delivery in favor of a cesarean section and close observation of those infants delivered by VE is warranted.
Collapse
|
30
|
Abstract
Operative vaginal delivery has been maligned since the days of W.J. Little with the word "forceps" becoming nearly synonymous with "Birth Injury" and "Cerebral Palsy." However in his presentation to the Obstetrical Society of London in 1861, Little's emphasis was on difficult labors being the culprit in subsequent disabilities in the offspring. Instrumented deliveries in that era were the end result of a long, obstructed labor performed for maternal benefit and to avoid a destructive procedure to the fetus thus allowing a chance at life. If there had been a normal progress in labor, operative assistance for delivery would not have been needed. Thus, was it the instrument or the obstructed labor that led to fetal injury? In this article, we will review what injuries to the fetus and the mother can be directly attributable to the instrument. We will explore the processes of labor, conduct of labor management, and concurrent fetal factors that can modulate the occurrence of birth trauma. Evidence regarding inexperience and improper use as contributing to injury will also be explored.
Collapse
Affiliation(s)
- Dena R Towner
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California 95817, USA.
| | | |
Collapse
|
31
|
|
32
|
|
33
|
Simonson C, Barlow P, Dehennin N, Sphel M, Toppet V, Murillo D, Rozenberg S. Neonatal complications of vacuum-assisted delivery. Obstet Gynecol 2007; 109:626-33. [PMID: 17329513 DOI: 10.1097/01.aog.0000255981.86303.2b] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess systematically the extent of neonatal complications in a cohort of vacuum-assisted deliveries, identify risk factors associated with the occurrence of these complications, and to evaluate the usefulness of skull X-ray and transfontanellar ultrasonography after vacuum extraction. METHODS We reviewed a cohort of 1,123 attempted vacuum extractions of singletons performed between January 2000 and December 2004. During this period, a systematic screening using transfontanellar ultrasonography and skull X-ray was performed after vacuum extraction. RESULTS Among 913 successful vacuum-assisted, full-term deliveries, 25.7% were admitted to the neonatal intensive care unit. Scalp edema, cephalhematoma, and skull fracture were assessed by cranial radiography and were present in, respectively, 18.7%, 10.8%, and 5.0% of cases. Intracranial hemorrhage occurred in eight cases (0.87%). Nulliparity, a vacuum attempt at mid station, an extraction requiring more than three tractions, and dislodgment of the cup were associated with these complications but had a low predictive value. CONCLUSION Severe neonatal complications associated with vacuum extraction are uncommon. Systematic X-ray and ultrasonographic examination led to the discovery of asymptomatic complications. Because the clinical significance of these complications is unknown, we do not recommend them as routine screening tools. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Colin Simonson
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Buxelles, Brussels, Belgium
| | | | | | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- P Deruelle
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France.
| |
Collapse
|
35
|
Vacca A. Vacuum-assisted delivery: An analysis of traction force and maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol 2006; 46:124-7. [PMID: 16638034 DOI: 10.1111/j.1479-828x.2006.00540.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Safety recommendations for vacuum-assisted delivery focus on limiting the number of pulls and the duration of the procedure. With the introduction of the Kiwi OmniCup vacuum extractor incorporating a Traction Force Indicator, it is now possible to reliably monitor and control the amount of traction force exerted on the fetal scalp. The OmniCup was used in a prospective observational study of 119 vacuum-assisted deliveries in nulliparous women to establish practical guidelines for safe practice in typical clinical settings.
Collapse
Affiliation(s)
- Aldo Vacca
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| |
Collapse
|
36
|
Boo NY, Mahdy Z. Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. BJOG 2006. [DOI: 10.1111/j.1471-0528.2006.00911.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
37
|
Abstract
PURPOSE OF REVIEW The types, mechanisms and clinical manifestations of head injuries (extracranial, cranial and intracranial) after instrumental delivery are described along with current evidence of their prevention and management. RECENT FINDINGS Asymptomatic subdural hematomas can occur in up to 6.1% of uncomplicated vaginal deliveries. Maternal nulliparity, incorrect placement of vacuum extraction cup and failed vacuum extraction are predisposing factors to subgaleal hemorrhage. Injuries associated with the vacuum devices may be minimized if the recommended limits for a safe traction force are not exceeded. There is no difference in the incidence of scalp trauma between vacuum deliveries by a rigid plastic cup (Omnicup) and the standard, silastic cup. The use of a metal cup may increase the occurrence of head injuries. Protective covers over forceps reduce the rates of neonatal facial abrasions and skin bruises. There is no difference in the incidence of cephalhematoma comparing a sequential operative vaginal delivery and a caesarean section following a failed vacuum delivery. SUMMARY Instrumental vaginal deliveries carry substantial risks. Only practitioners who are adequately trained or are under supervision should undertake instrumental delivery. The mode of intervention needs to be individualized after consideration of the operator's skills and experience and the clinical circumstances.
Collapse
Affiliation(s)
- Stergios K Doumouchtsis
- Department of Obstetrics and Gynaecology, St George's Hospital, St George's University of London, London, UK.
| | | |
Collapse
|
38
|
Vacca A. Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. BJOG 2006; 113:491; author reply 491-2. [PMID: 16553661 DOI: 10.1111/j.1471-0528.2006.00910.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|