Mild neonatal complications following guideline-compliant vacuum-assisted delivery in Japan: improvements still needed

Abstract

Introduction Neonatal cephalohematoma and hyperbilirubinemia are often encountered after vacuum-assisted delivery. For safe obstetric practice, guidelines for vacuum procedure were published in 2014 in Japan. We aimed to identify the risk of mild neonatal complications since guideline introduction. Methods This retrospective observational study included singleton deliveries at term gestation from 2015 to 2019 at a single perinatal center in Japan. Incidences of neonatal jaundice requiring phototherapy, cephalohematoma, and umbilical artery pH <7.10 were determined and risk factors relevant to the development of hyperbilirubinemia were evaluated. Results Of 1010 deliveries during the study period, vacuum procedures were attempted in 183 (18%). Guideline recommendations were fully adhered to in over 98% of vacuum procedures. Phototherapy for neonatal hyperbilirubinemia was performed in 75 (41%) of 183 deliveries with vacuum procedure, cephalohematoma occurred in 35 (19%), and umbilical artery pH <7.10 was observed in 10 (5.5%), all of which were significantly higher than without vacuum procedure, such as hyperbilirubinemia (11%, risk ratio [RR] = 3.8, 95% confidence interval [CI] = 2.9 − 4.9, p < .0001), cephalohematoma (1.0%, RR = 19.8, 95%CI = 9.3 − 41.9, p < .0001), and umbilical artery pH <7.10 (0.6%, RR = 9.0, 95%CI = 3.1 − 26.1, p < .0001). Multiple logistic regression analysis demonstrated that vacuum procedure was the factor most strongly associated with neonatal hyperbilirubinemia (odds ratio = 3.5, 95%CI = 2.2 − 5.5, p < .0001). Discussion Vacuum procedure is an important option for the safe vaginal delivery. However, neonates should be observed for development of jaundice to prevent kernicterus even after optimally performed vacuum-assisted delivery.