Abstract
BackgroundVery few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD).MethodsData was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010, all live-born, singleton preterm infants in a non-breech presentation at birth, born after onset of labor (either spontaneously, by induction, or by rupture of membranes) by VD, CS, or VE were included, leaving a study population of 40,764 infants. Logistic regression analyses were used to calculate adjusted odds ratios (AOR), using unassisted vaginal delivery as reference group.ResultsVE was used in 5.7% of the preterm deliveries, with lower rates in earlier gestations. Overall, intracranial hemorrhage (ICH) occurred in 1.51%, extracranial hemorrhage (ECH) in 0.64%, and brachial plexus injury in 0.13% of infants. Infants delivered by VE had higher risks for ICH (AOR = 1.84 (95% CI: 1.09-3.12)), ECH (AOR = 4.48 (95% CI: 2.84-7.07)) and brachial plexus injury (AOR = 6.21 (95% CI: 2.22-17.4)), while infants delivered by CS during labor had no increased risk for these complications, as compared to VD.ConclusionWhile rates of neonatal complications after VE are generally low, higher odds ratios for intra- and extracranial hemorrhages and brachial plexus injuries after VE, compared with other modes of delivery, support a continued cautious use of VE for preterm delivery.
Highlights
Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive
Use of VE in relation to gestational age Among the 40,764 (54% of all) preterm deliveries included in this study, 2,319 (5.7%) preterm infants were delivered by VE, 5,505 (13.5%) by cesarean section during labor (CS) during labor, and 32,940 (80.2%) by vaginal delivery (VD)
The VE rate decreased with maternal height and 80% of the women who delivered by VE were primiparae, compared with 48% of those who underwent CS during labor
Summary
Very few studies have investigated the neonatal outcomes after vacuum extraction delivery (VE) in the preterm period and the results of these studies are inconclusive. The objective of this study was to describe the use of VE for preterm delivery in Sweden and to compare rates of neonatal complications after preterm delivery by VE to those found after cesarean section during labor (CS) or unassisted vaginal delivery (VD). Neonatal outcomes in preterm infants delivered vaginally or by cesarean section (CS) [2,3,4,5] have been compared, there is no evidence to provide clear guidance on the method of choice [6]. Given the widespread assumption that assisted vaginal delivery could be harmful for fragile infants that are underweight and preterm, very few studies have addressed the use of vacuum extraction (VE) for preterm birth. A cesarean section, on the other hand, can be performed at any stage of labor and does not require prerequisites of this kind
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