Vacuum extraction and risk of neonatal complications: a population-based cohort study

INTRODUCTION The aim of the present study was to investigate the association between birth weight, use of vacuum extractor and neonatal outcome among infants born at term with a birth weight ≥ 4,500 g. METHODS This population-based cohort study used data from the Garda Hospital from 2001 to 2016, including 370 births at gestational age > 36 completed weeks. We categorized our sample into non-instrumental vaginal delivery (VD), vacuum extraction (VE) or cesarean section following attempted vacuum extraction (VE + CS). The following outcomes were assessed: 5-min Apgar score < 7, neonatal convulsions, intracranial hemorrhage, and brachial plexus injury. RESULTS The odds ratios for all complications increased among infants born after VE/VE + CS and VD. The highest risks were seen after VE/VE + CS with an adjusted odds ratio for neonatal convulsions of 8.4 (95% CI 5.3-11.2) among infants with a birthweight ≥ 4,500 g. The corresponding adjusted odds ratios for intracranial hemorrhage were 8.7 (95% CI 4.3-14.6) and for brachial plexus injury 85.4 (95% CI 75.9-103.4). CONCLUSIONS Vacuum extraction is a risk factor for negative neonatal outcomes, in particular when used in infants born at term with a birthweight ≥ 4,500 g.