Document Detail

Effect of mode of delivery in nulliparous women on neonatal intracranial injury.
MedLine Citation:
PMID:  10580069     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Infants delivered by vacuum extraction or other operative techniques may be more likely to sustain major injuries than those delivered spontaneously, but the extent of the risk is unknown. METHODS: From a California data base, we identified 583,340 live-born singleton infants born to nulliparous women between 1992 and 1994 and weighing between 2500 and 4000 g. One third of the infants were delivered by operative techniques. We evaluated the relation between the mode of delivery and morbidity in the infants. RESULTS: Intracranial hemorrhage occurred in 1 of 860 infants delivered by vacuum extraction, 1 of 664 delivered with the use of forceps, 1 of 907 delivered by cesarean section during labor, 1 of 2750 delivered by cesarean section with no labor, and 1 of 1900 delivered spontaneously. As compared with the infants delivered spontaneously, those delivered by vacuum extraction had a significantly higher rate of subdural or cerebral hemorrhage (odds ratio, 2.7; 95 percent confidence interval, 1.9 to 3.9), as did the infants delivered with the use of forceps (odds ratio, 3.4; 95 percent confidence interval, 1.9 to 5.9) or cesarean section during labor (odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.4), but the rate of subdural or cerebral hemorrhage associated with vacuum extraction did not differ significantly from that associated with forceps use (odds ratio for the comparison with vacuum extraction, 1.2; 95 percent confidence interval, 0.7 to 2.2) or cesarean section during labor (odds ratio, 0.9; 95 percent confidence interval, 0.6 to 1.4). CONCLUSIONS: The rate of intracranial hemorrhage is higher among infants delivered by vacuum extraction, forceps, or cesarean section during labor than among infants delivered spontaneously, but the rate among infants delivered by cesarean section before labor is not higher, suggesting that the common risk factor for hemorrhage is abnormal labor.
D Towner; M A Castro; E Eby-Wilkens; W M Gilbert
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The New England journal of medicine     Volume:  341     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1999 Dec 
Date Detail:
Created Date:  1999-12-02     Completed Date:  1999-12-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1709-14     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of California Davis-Sacramento 95817, USA.
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MeSH Terms
Birth Injuries / epidemiology,  etiology*
California / epidemiology
Cesarean Section / adverse effects
Delivery, Obstetric / adverse effects*,  methods
Dystocia / complications
Extraction, Obstetrical / adverse effects
Infant, Newborn
Intracranial Hemorrhage, Traumatic / epidemiology,  etiology*
Retrospective Studies
Risk Factors
Vacuum Extraction, Obstetrical / adverse effects
Comment In:
N Engl J Med. 2000 Mar 23;342(12):892-3   [PMID:  10733373 ]
N Engl J Med. 1999 Dec 2;341(23):1758-9   [PMID:  10580076 ]
N Engl J Med. 2000 Mar 23;342(12):893   [PMID:  10733374 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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