Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Acta Obstet Gynecol Scand. 2019 Nov;98(11):1464-1472. doi: 10.1111/aogs.13678. Epub 2019 Jul 26.
Subgaleal hemorrhage (SGH) is a life-threatening neonatal condition that is strongly associated with vacuum assisted delivery (VAD). The factors associated with the development of SGH following VAD are not well-established. We aimed to evaluate the factors associated with the development of SGH following attempted VAD.
A retrospective case-control study of women who delivered at a tertiary university-affiliated medical center in Jerusalem, Israel, during 2009-2018. Cases comprised all parturients with singleton pregnancies for whom attempted VAD resulted in neonatal SGH. A control group of VAD attempts was established by matching one-to-one according to gestational age at delivery, parity and year of delivery. Fetal, intrapartum and vacuum procedure characteristics were compared between the groups.
In all, 313 (89.5%) of the 350 attempted VAD were nulliparous. Baseline maternal and fetal characteristics were similar between the groups except for higher neonatal birthweight in the SGH group. In multivariate logistic regression analysis, only six independent risk factors were significantly associated with the development of SGH: second-stage duration (for each 30-minute increase, adjusted odds ratio [OR] 1.13; 95% confidence intervals [CI] 1.04-1.25; P = .006), presence of meconium-stained amniotic fluid (adjusted OR 2.61; 95% CI 1.52-4.48; P = .001), presence of caput succedaneum (adjusted OR 1.79; 95% CI 1.11-2.88; P = .01), duration of VAD (for each 3-minute increase, adjusted OR 2.04; 95% CI 1.72, 2.38; P < .001), number of dislodgments (adjusted OR 2.38; 95% CI 1.66-3.44; P < .001), and fetal head station (adjusted OR 3.57; 95% CI 1.42-8.33; P = .006). Receiver operating characteristic curves showed that VAD duration of ≥15 minutes had a 96.7% sensitivity and 75.0% specificity in predicting SGH formation, with an area under the curve equal to .849.
Vacuum duration, the number of dislodgments, the duration of second stage of delivery, fetal head station, the presence of caput succedaneum and the presence of meconium were found to be independently associated with SGH formation.
头皮下血肿（SGH）是一种危及生命的新生儿病症，与真空辅助分娩（VAD）密切相关。与 VAD 后 SGH 发展相关的因素尚未得到很好的确定。我们旨在评估尝试 VAD 后 SGH 发展的相关因素。
这是一项在以色列耶路撒冷的一家三级大学附属医院进行的回顾性病例对照研究。病例组包括所有因尝试 VAD 而导致新生儿 SGH 的单胎妊娠产妇。通过根据分娩时的胎龄、产次和分娩年份进行一对一匹配，建立 VAD 尝试的对照组。比较两组之间的胎儿、产时和真空程序特征。
在所有 350 次尝试的 VAD 中，有 313 次（89.5%）为初产妇。除了 SGH 组新生儿出生体重较高外，两组的基线产妇和胎儿特征相似。在多变量逻辑回归分析中，只有 6 个独立的危险因素与 SGH 的发生显著相关：第二产程时间（每增加 30 分钟，调整后的优势比 [OR] 1.13；95%置信区间 [CI] 1.04-1.25；P =.006）、羊水胎粪污染（调整后的 OR 2.61；95% CI 1.52-4.48；P =.001）、帽状腱膜下血肿（调整后的 OR 1.79；95% CI 1.11-2.88；P =.01）、VAD 时间（每增加 3 分钟，调整后的 OR 2.04；95% CI 1.72, 2.38；P <.001）、脱位次数（调整后的 OR 2.38；95% CI 1.66-3.44；P <.001）和胎头位置（调整后的 OR 3.57；95% CI 1.42-8.33；P =.006）。受试者工作特征曲线显示，VAD 持续时间≥15 分钟预测 SGH 形成的灵敏度为 96.7%，特异性为 75.0%，曲线下面积等于 0.849。
真空持续时间、脱位次数、第二产程时间、胎头位置、帽状腱膜下血肿的存在以及胎粪的存在与 SGH 的形成独立相关。
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