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.