Association between vacuum extraction and subgaleal haemorrhage: can intrapartum ultrasound reduce the risks?

Choi-Wah KONG; William WK TO

doi:10.12809/hkjgom.22.1.07

Authors

Choi-Wah KONG
William WK TO

DOI:

https://doi.org/10.12809/hkjgom.22.1.07

Keywords:

Hemorrhage, Ultrasonography, Vacuum extraction, obstetrical

Abstract

Vacuum extraction is a common procedure in the labour ward. Subgaleal haemorrhage is a rare neonatal complication that can be life threatening. We examine the risk factors associated with subgaleal haemorrhage after vacuum extraction, including fetal head malposition and inappropriate cup placement, and the role of intrapartum ultrasound in reducing perinatal complications. Although there is an increasing trend for using intrapartum ultrasound for more precise diagnosis of fetal head position, there is no evidence that this practice reduces failed vacuum delivery rates or perinatal morbidity.

References

Verma GL, Spalding JJ, Wilkinson MD, Hofmeyr GJ, Vannevel V, O’Mahony F. Instruments for assisted vaginal birth. Cochrane Database Syst Rev 2021;9:CD005455.

Chung WH, Li YY, Kong CW, To WWK. Association between rates of second-stage Caesarean section and instrumental delivery. Hong Kong J Gynaecol Obstet Midwifery 2019;19:89-95.

Aiken CE, Aiken AR, Brockelsby JC, Scott JG. Factors influencing the likelihood of instrumental delivery success. Obstet Gynecol 2014;123:796-803.

Verhoeven CJ, Nuij C, Janssen-Rolf CR, et al. Predictors for failure of vacuum-assisted vaginal delivery: a case-control study. Eur J Obstet Gynecol Reprod Biol 2016;200:29-34.

Murphy DJ, Strachan BK, Bahl R; Royal College of Obstetricians Gynaecologists. Assisted Vaginal Birth. Greentop Guidelines No. 26. BJOG 2020;127:e70-e112.

Chadwick LM, Pemberton PJ, Kurinczuk JJ. Neonatal subgaleal haematoma: associated risk factors, complications and outcome. J Paediatr Child Health 1996;32:228-32.

Neonatal Subgaleal Haemorrhage Practice Recommendation. New Zealand Newborn Clinical Network; 2021.

Prevention, Detection, and Management of Subgaleal Haemorrhage in the Newborn. The Royal Australian and New Zealand College Obstetricians and Gynaecologists; November 2015.

Levin G, Elchalal U, Yagel S, et al. Risk factors associated with subgaleal hemorrhage in neonates exposed to vacuum extraction. Acta Obstet Gynecol Scand 2019;98:1464-72.

Uchil D, Arulkumaran S. Neonatal subgaleal hemorrhage and its relationship to delivery by vacuum extraction. Obstet Gynecol Surv 2003;58:687-93.

Boo NY, Foong KW, Mahdy ZA, Yong SC, Jaafar R. Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction. BJOG 2005;112:1516-21.

Swanson AE, Veldman A, Wallace EM, Malhotra A. Subgaleal hemorrhage: risk factors and outcomes. Acta Obstet Gynecol Scand 2012;91:260-3.

Ramphul M, Ooi PV, Burke G, et al. Instrumental delivery and ultrasound: a multicentre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery. BJOG 2014;121:1029-38.

Doumouchtsis SK, Arulkumaran S: Head injuries after instrumental vaginal deliveries. Curr Opin Obstet Gynecol 2006;18:129-34.

Ekéus C, Högberg U, Norman M. Vacuum assisted birth and risk for cerebral complications in term newborn infants: a population-based cohort study. BMC Pregnancy Childbirth 2014;14:36.

Tempest N, Lane S, Hapangama D; UK Audit Research Trainee Collaborative in Obstetrics and Gynecology (UK-ARCOG). Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position in the second stage of labor: a prospective observational study. Acta Obstet Gynecol Scand 2020;99:537-45.

To WW, Li IC. Occipital posterior and occipital transverse positions: reappraisal of the obstetric risks. Aust NZ J Obstet Gynaecol 2000;40:275-9.

Ahlberg M, Norman M, Hjelmstedt A, Ekeus C. Risk factors for failed vacuum extraction and associated complications in term newborn infants: a population-based cohort study. J Matern Fetal Neonatal Med 2016;29:1646-51.

Ashwal E, Wertheimer A, Aviram A, et al. The association between fetal head position prior to vacuum extraction and pregnancy outcome. Arch Gynecol Obstet 2016;293:567-73.

Palatnik A, Grobman WA, Hellendag MG, Janetos TM, Gossett DR, Miller ES. Predictors of failed operative vaginal delivery in a contemporary obstetric cohort. Obstet Gynecol 2016;127:501-6.

Haikin EH, Mankuta D. Vacuum cup placement during delivery: a suggested obstetric quality assessment measure. J Matern Fetal Neonatal Med 2012;25:2135-7.

Bird GC. The importance of flexion in vacuum extractor delivery. Br J Obstet Gynaecol 1976;83:194-200.

Sutter MB, Hagee SR. Assisted Vaginal Delivery. In: Advanced Life Support in Obstetrics Provider Manual, 9th ed. Leeman L, Dresang L, Quinlan JD, Magee SR, editors. American Academy of Family Physicians; 2020.

Yeomans ER. Operative Vaginal Delivery. In: Operative Obstetrics, 3rd ed. Yeomans ER, Hoffman BL, Gilstrap III LC, Cunningham FG, editors. McGraw-Hill New York; 2017.

Chan VYT, Hui W, Lau WL. Role of intrapartum ultrasound in modern obstetrics. Hong Kong J Gynaecol Obstet Midwifery 2017;17:134-40.

Akmal S, Kametas N, Tsoi E, Hargreaves C, Nicolaides KH. Comparison of transvaginal digital examination with intrapartum sonography to determine fetal head position before instrumental delivery. Ultrasound Obstet Gynecol 2003;21:437-40.

Dietz HP, Lanzarone V. Measuring engagement of the fetal head: validity and reproducibility of a new ultrasound technique. Ultrasound Obstet Gynecol 2005;25:165-68.

Eggebo TM, Gjessing LK, Heien C, et al. Prediction of labor and delivery by transperineal ultrasound in pregnancies with prelabor rupture of membrane sat term. Ultrasound Obstet Gynecol 2006;27:387-91.

Wong GY, Mok YM, Wong SF. Transabdominal ultrasound assessment of the fetal head and the accuracy of vacuum cup application. Int J Gynaecol Obstet 2007;98:120-3.

Ramphul M, Kennelly MM, Burke G, Murphy DJ. Risk factors and morbidity associated with suboptimal instrument placement at instrumental delivery: observational study nested within the Instrumental Delivery and Ultrasound randomised controlled trial ISRCTN 72230496. BJOG 2015;122:558-63.

Popowski T, Porcher R, Fort J, Javoise S, Rozenberg P. Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial. Ultrasound Obstet Gynecol 2015;46:520-5.

Ghi T, Dall’Asta A, Masturzo B, et al. Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.). Ultrasound Obstet Gynecol 2018;52:699-705.

Barros JG, Afonso M, Martins AT, et al. Transabdominal and transperineal ultrasound vs routine care before instrumental vaginal delivery: a randomized controlled trial. Acta Obstet Gynecol Scand 2021;100:1075-81.

Mappa I, Tartaglia S, Maqina P, et al. Ultrasound vs routine care before instrumental vaginal delivery: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021;100:1941-8.

Ghi T, Eggebo T, Lees C, et al. ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound Obstet Gynecol 2018;52:128-39.

Ghi T. Sonographic confirmation of fetal position before operative vaginal delivery should be recommended in clinical guidelines. Ultrasound Obstet Gynecol 2021;57:36-7.