Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction

Nem Yun Boo, Kin Wai Foong, Zaleha Abdullah Mahdy, Sin Chuen Yong, Rohana Jaafar

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objectives: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. Design: A prospective observational study. Setting: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population: All infants born in the hospital with a history of exposure to vacuum extraction. Methods: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results: Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). Conclusion: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.

Original languageEnglish
Pages (from-to)1516-1521
Number of pages6
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume112
Issue number11
DOIs
Publication statusPublished - Nov 2005

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Vacuum
Hemorrhage
Odds Ratio
Confidence Intervals
Cranial Fontanelles
Sutures
Parity
Observational Studies
Mothers
Prospective Studies
Birth Order
Apgar Score
Neonatal Intensive Care Units
Scalp
Tertiary Care Centers
Skull
Teaching Hospitals
Obstetrics
Logistic Models
Head

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. / Boo, Nem Yun; Foong, Kin Wai; Abdullah Mahdy, Zaleha; Yong, Sin Chuen; Jaafar, Rohana.

In: BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 112, No. 11, 11.2005, p. 1516-1521.

Research output: Contribution to journalArticle

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abstract = "Objectives: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. Design: A prospective observational study. Setting: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population: All infants born in the hospital with a history of exposure to vacuum extraction. Methods: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results: Of 10,066 infants born in the hospital during the study period, 338 (3.4{\%}) had exposure to vacuum extraction. SAH was detected in 71 (21.0{\%}) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95{\%} confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95{\%} CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95{\%} CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95{\%} CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95{\%} CI: 1.7, 21.0). Conclusion: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.",
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AU - Jaafar, Rohana

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N2 - Objectives: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. Design: A prospective observational study. Setting: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population: All infants born in the hospital with a history of exposure to vacuum extraction. Methods: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results: Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). Conclusion: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.

AB - Objectives: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. Design: A prospective observational study. Setting: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. Population: All infants born in the hospital with a history of exposure to vacuum extraction. Methods: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. Main outcome measures: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. Results: Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). Conclusion: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.

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