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PubMed1996

Trial of labor in patients with a previous lower uterine vertical cesarean section.

OBJECTIVE: Our purpose was to determine the efficacy and safety of a trial of labor in patients previously delivered at least once by a lower uterine vertical cesarean section. STUDY DESIGN: A retrospective review was performed at a single tertiary perinatal center, The University of Florida Health Science Center, Jacksonville. The medical records of all patients with a previous low vertical cesarean section who underwent a trial of labor during a 72-month period from January 1988 until December 1993 were reviewed. The medical records of the next two patients who did not have a prior uterine incision admitted to labor and delivery after the index case served as the controls. The duration and outcome of labor, including mode of delivery, maternal and perinatal morbidity, and birth trauma were evaluated. RESULTS: Of 77 patients with a previous low vertical cesarean incision, 11 (14.3%) had a repeat operation compared with 14 of 154 patients (9.0%) in the no previous cesarean section group (not significant). No differences were noted in the incidences of operative vaginal deliveries or prolonged duration of the first or second stages of labor, or in the rate or maximum dose of oxytocin infusion between the two groups. One patient in the previous cesarean section group had uterine rupture. The incidence of umbilical artery pH < or = 7.20 was similar. No difference in the number of infants with 1- or 5-minute Apgar scores < or = 7 was noted. CONCLUSION: A trial of labor in women with previous low vertical cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.

Adult↗
PubMed1995

Labor induction in patients with previous cesarean section.

To determine the efficacy and safety of labor induction in patients previously delivered by at least one low transverse cesarean section, a retrospective review was done at a single tertiary perinatal center, the University of Florida Health Science Center, Jacksonville. All patients with a previous cesarean section who required labor induction from 1988 until the end of 1992 were identified. Duration and outcome of labor induction, including mode of delivery, maternal and perinatal morbidity, and birth trauma, were evaluated. Of 160 patients with a previous cesarean, 50 (31.3%) had a repeat operation compared to 18 (11.2%) in the no previous cesarean group (p = 0.001, odds ratio = 3.59; 95% confidence interval, 1.98, 6.49). Women in the cesarean group had a higher incidence of operative vaginal deliveries, prolonged duration of the first and second stages of labor, rate and maximum dose of oxytocin infusion. One patient in the previous cesarean group experienced uterine rupture. There was no difference in the rate of infants with low 5-minute Apgar scores or with cord pH values less than 7.20. Labor induction in women with previous low transverse cesarean sections results in an acceptable rate of vaginal delivery and appears safe for both mother and fetus.

Adult↗
PubMed1987

Comparative maternal, fetal, and neonatal effects of chloroprocaine with and without epinephrine for epidural anesthesia in obstetrics.

The effects of epidural chloroprocaine with and without 1:200,000 epinephrine during labor and delivery on uterine activity, progress of labor, fetal heart rate, maternal blood pressure, newborn Apgar scores, neonatal acid-base status, and the Neurologic and Adaptive Capacity Scoring System (NACS) were compared in 28 parturients. Patients in group I (n = 14) received 2% chloroprocaine with 1:200,000 epinephrine and patients in group II (n = 14) received 2% plain chloroprocaine. Addition of epinephrine to chloroprocaine had no significant effects on uterine activity, duration of first or second stages of labor, or fetal heart parameters. Apgar scores, neonatal acid-base status, and the NACS were equally good in the two groups. Duration of analgesia was significantly longer in group I than in group II patients (76 +/- 3.8 vs 42.9 +/- 1 min, P less than 0.001). We conclude that addition of epinephrine to chloroprocaine during epidural anesthesia in the normal parturient has no adverse effects on mother, fetus, neonate, or the progress of labor and that it significantly prolongs the duration of anesthesia.

Acid-Base Equilibrium↗
PubMed1986

[Comprehensive approach to the clinical study of the administration of dehydroepiandrosterone-sulfate (DHA-S) during the induction of labor].

Effects of Dehydroepiandrosterone-Sulfate (DHA-S) administration during the induction of labor were analysed comprehensively in 116 cases of primipara without any complications. In all of the patients delivery was induced by means of intravenous drip infusion of oxytocin. DHA-S was given as follows; Group A: no administration of DHA-S, Group B: intravenous drip infusion of 600 mg of DHA-S, Group C: intravenous injection of 200 mg of DHA-S every two hours (max, five times). The duration of the first and second stages of labor was reduced significantly in Group C compared to that of Group A (p less than 0.02). Serum DHA-S and estradiol levels in the patients in Groups B and C were significantly higher than those in Group A during the induction of the labor (p less than 0.05-0.005). The secretion of maternal milk was suppressed transiently by the administration of DHA-S (p less than 0.05-0.005), and there was a significant negative correlation between the total amount of maternal milk secretion and the total dose of DHA-S (r = -0.6320, p less than 0.005). Maternal serum prolactin levels did not change significantly following the administration of DHA-S, but estradiol increased significantly following the administration of DHA-S until 48 hours after delivery. These facts suggested that the intravenous injection of 200mg of DHA-S every two hours was effective in assisting the induction of labor, and the transient suppression of maternal milk secretion due to the administration of DHA-S might be caused by the high level of maternal serum estradiol which was converted from DHA-S in the placenta.

Adult↗
PubMed2002

Should intrathecal narcotics be used as a sole labor analgesic? A prospective comparison of spinal opioids and epidural bupivacaine.

OBJECTIVE: Intrathecal narcotics (ITNs) are being used in some settings as a sole labor analgesic. However, they have not been directly compared to epidural analgesia. STUDY DESIGN: We used a prospective observational design. POPULATION: Eighty-two women with uncomplicated full-term pregnancies were enrolled upon analgesia request during spontaneous labor with cervical dilation 3 to 7 cm. Sixty-three chose ITNs (morphine and fentanyl), and 19 chose epidural analgesia (continuous infusion of bupivacaine and fentanyl). OUTCOMES MEASURED: Pain scores were documented using a visual analog scale. Satisfaction and side effects were rated with Likert scales during a structured interview on the first postpartum day. Outcomes were analyzed with multivariate regression techniques. RESULTS: Intrathecal narcotics were associated with significantly higher pain scores than was epidural analgesia during the first and second stages of labor and on an overall postpartum rating. The median effective duration of action for ITNs was between 60 and 120 minutes; however, ITNs provided excellent analgesia for a subgroup of women who delivered within 2 to 3 hours of receiving them. Although women in both groups were satisfied with their pain management, women receiving ITNs had statistically lower overall satisfaction scores. CONCLUSIONS: Within the limitations of a nonrandomized study, a single intrathecal injection of morphine and fentanyl has a shorter duration of action and provides less effective pain control than a continuous epidural infusion of bupivacaine and fentanyl. However, ITNs may have a role in settings with limited support from anesthesiologists or for women whose labors are progressing rapidly.

Adult↗
PubMed1992

Prophylactic intrapartum amnioinfusion for patients with oligohydramnios. A prospective randomized study.

This prospective study evaluated whether prophylactic saline amnioinfusion among patients with amniotic fluid index (AFI) < or = 5.0 cm decreases the incidence of adverse fetal outcomes. Randomization of 53 patients with decreased AFI at term, resulted in 21 patients' receiving prophylactic saline amnioinfusion early in labor, prior to development of an abnormal fetal heart rate tracing. For the treatment group the mean AFI on admission was 3.0 cm, and the postamnioinfusion AFI was 8.9 cm. For 32 comparison (noninfusion) patients, the mean AFI was 2.9 cm; the group consisted of 17 patients randomized to receive no amnioinfusion (control group) and 15 patients who refused to participate in the study. There was no statistically significant difference between the amnioinfused and nonamnioinfused patients with regard to age, parity, gestational age, AFI at admission or duration of first or second stage of labor. Amnioinfusion resulted in no statistically significant reduction in the incidence of recurrent variable decelerations/bradycardia (26.3% vs. 46.6%), intrapartum resuscitation with terbutaline (5.2% vs. 10.0%), cesarean section for fetal distress (9.5% vs. 9.3%), fetal-acidosis (10.5% vs. 12.0%) or Apgar scores < 7 at five minutes (5.2% vs. 0%) in patients with oligohydramnios.

Amniotic Fluid↗
PubMed1997

The efficacy of intrathecal coadministration of morphine and bupivacaine for labor analgesia.

BACKGROUND: Intrathecal (i.t.) opioids can provide labor analgesia, but the onset of pain relief is slow. Bupivacaine has the beneficial property of less motor blockade than other local anesthetics. This study retrospectively examined the efficacy of concomitant use of i.t. morphine and bupivacaine for labor pain relief. METHODS: Fifty five nulliparas who requested analgesia in the active phase (IA group) prior to a cervical dilation 3.9 +/- 0.6 cm and received i.t. morphine 0.5 mg and 0.1% bupivacaine 2.5 mg served as the treatment group, and 88 similar nulliparas who did not request and receive analgesia served as the control group. RESULTS: The mean onset time of analgesia was 2.6 +/- 0.5 min, the duration was 4-12 h and 93% of parturients did not request additional analgesia after a single injection of i.t. morphine and bupivacaine. The active phase of the first and second stages of labor in the treatment group were significantly longer [318 +/- 214 min vs. 176 +/- 120 min; 74 +/- 29 min vs. 37 +/- 26 min]. Frequency of instrument-assisted vaginal delivery was higher compared with the control group (30.9% vs. 14.1%). However, there were no significant differences in the rate of cesarean section and the Apgar scores of newborns at 1 min and 5 min between the treatment and control group. The major side effects of the treatment group included pruritus (48%), nausea (40%), vomiting (37%), somnolence (27%), shivering (27%), urinary retention (21%), hypotension (15%), and bradycardia (13%). Most of the side effects were mild and could be alleviated by naloxone. Neither post-spinal headache nor respiratory depression was noted. CONCLUSIONS: Our results showed that a single injection of i.t. morphine and bupivacaine provided rapid onset and effective analgesia with manageable side effects and without major complications. Thus, i.t. morphine and bupivacaine provides an alternative to epidural analgesia for most women in labor.

Adult↗
PubMed2004

Patient-controlled epidural technique improves analgesia for labor but increases cesarean delivery rate compared with the intermittent bolus technique.

BACKGROUND: We tested the hypothesis that patient-controlled epidural analgesia for labor (PCEA) provides better analgesia and satisfaction than the intermittent bolus technique (bolus) without affecting the mode of delivery. METHODS: We randomized 187 parturients to receive labor analgesia using either the PCEA or bolus technique. The PCEA group received a starting bolus of 14 mg of bupivacaine and 60 micro g of fentanyl in a 15-ml volume, followed by a background infusion (bupivacaine 0.08% and fentanyl 2 microg ml(-1)) 5 ml h(-1) with a 5-ml bolus and 15-min lock-out interval. The bolus group received boluses of 20 mg of bupivacaine and 75 micro g of fentanyl in a 15-ml volume. RESULTS: Parturients in the PCEA group had significantly (P < 0.05-0.01) less pain during the first and second stages of labor. There was no difference in the spontaneous delivery rate between the groups, but the cesarean delivery rate was significantly (P < 0.05) higher (16.3% vs. 6.7%) in the PCEA group than in the bolus group. Bupivacaine consumption was significantly (P < 0.01) higher (11.2 mg h(-1) vs. 9.6 mg h(-1)) and the second stage of labor was significantly (P < 0.01) longer (70 min vs. 54 min) in the PCEA group than in the bolus group. Patient satisfaction was equally good in both groups. CONCLUSION: The PCEA technique provided better pain relief. This was associated with higher bupivacaine consumption, prolongation of the second stage of labor, and an increased rate of cesarean section.

Adolescent↗
PubMedDate not supplied

Epidural butorphanol augments lidocaine sensory anesthesia during labor.

To determine the efficacy and safety of epidural butorphanol combined with lidocaine, 50 healthy parturients were studied during labor and delivery. All patients received a test dose of 3 ml 1.5% lidocaine with 1:200,000 epinephrine. Patients were then randomly assigned to receive 7 ml of one of two epidural regimens in a double-blind fashion: Group 1 patients received 1.5% lidocaine plus 1 mg butorphanol plus 1:300,000 epinephrine; Group 2 patients received 1.5% lidocaine plus 1:300,000 epinephrine. Each group consisted of 25 patients. The study ended at the time of redosing. All subsequent epidural injections were made with one bolus of plain 0.25% bupivacaine followed by continuous infusion of 0.125% bupivacaine. Duration of anesthesia was significantly longer for Group 1 compared to Group 2 (p less than 0.01), 124 +/- 8 minutes versus 99 +/- 6 minutes (mean +/- SEM). There were no difference between groups in duration of first and second stages of labor, method of delivery or neonatal outcome. Umbilical cord acid-base status and neurologic adaptive capacity scores did not differ significantly between the two groups. The authors conclude that adding small doses of butorphanol to epidural lidocaine during labor is effective and safe.

Adult↗
PubMedDate not supplied

Epidural morphine or butorphanol augments bupivacaine analgesia during labor.

To determine the efficacy and the safety of epidural morphine or butorphanol combined with bupivacaine, 40 healthy parturients were studied during labor and delivery. All patients received an epidural test dose of 2 ml of 0.5% bupivacaine. Patients were then randomly assigned to receive one of four epidural regimens in a double-blind fashion: 0.25% bupivacaine + 1 mg butorphanol (Group I), 0.25% bupivacaine + 2 mg butorphanol (Group II), 0.25% bupivacaine + 2 mg morphine (Group III), or 0.25% bupivacaine alone (Group IV). Each group consisted of ten patients. All subsequent epidural injections were with plain 0.25% bupivacaine. Duration of analgesia was significantly longer for groups I, II, and III when compared to group IV (p less than or equal to .01); 139 +/- 111, 141 +/- 14, 199 +/- 29, and 96 +/- 6 minutes, X +/- SEM respectively. Quality of analgesia was significantly better in groups I, II, and III when compared with group IV. There were no differences between groups in duration of first and second stages of labor, uterine activity, or method of delivery. Thirty percent of patients in the morphine group (group III) developed mild pruritus that did not require any treatment. All neonates were vigorous at 5 minutes and had good Apgar Scores, umbilical cord acid base status, and Neurological Adaptive Capacity Scores. The authors conclude that adding small doses of either morphine or butorphanol to epidural bupivacaine during labor is effective and safe. Butorphanol may be preferable since none of the patients experienced pruritus.

Adult↗
PubMed1994

Double-blind comparison of intravenous butorphanol (Stadol) and fentanyl (Sublimaze) for analgesia during labor.

OBJECTIVE: Our purpose was to compare the analgesic properties, effect on labor, and maternal-fetal side effects of intravenous butorphanol and fentanyl. STUDY DESIGN: One hundred patients with uncomplicated term pregnancies were enrolled during early active labor. Each patient received standard doses of either fentanyl (50 to 100 micrograms) or butorphanol (1 to 2 mg) hourly on request in a double-blind manner. Pain was scored independently by the nurse and patient with a 10-point visual analog scale. Categoric and measurement data were collected for comparison of the effects on uterine activity, maternal and fetal well-being, and neonatal outcomes. RESULTS: The fentanyl (n = 50) and butorphanol (n = 50) groups were identical with respect to maternal age, race, parity, and weight. Greater improvement in pain relief was found after the first dose of butorphanol than after fentanyl (p < 0.05). When fentanyl was given, either more doses were necessary (3.2 +/- 1.3 vs 2.1 +/- 1.1, p < 0.01) or epidural analgesia was requested more often (16%, 32% vs 9%, 18%, p < 0.05). Uterine contraction patterns for the first hour after dosing were unchanged, and the duration of the first and second stages of labor were not different between the two groups. No differences in maternal or newborn adverse effects were observed. CONCLUSIONS: Both drugs were equally safe and without effect on active labor. Butorphanol provided better initial analgesia than fentanyl with fewer patient requests for more medication or epidural analgesia.

Adolescent↗
PubMed1984

Clinical significance of fetal heart rate patterns during labor. VIII. Breech presentations.

The fetal heart rate (FHR) tracings of 302 consecutive breech presentations were analyzed to assess their potential value in clinical practice. There were 274 singleton births, 27 first twins and 1 triplet. Ten percent of the gestations were greater than or equal to 42 weeks, and 26% were less than or equal to 36 weeks. Infants premature by weight (less than 2,500 gm) made up 32%. Only 33.3% had no decelerations, and 63.0% had variable or variable-late decelerations. The latter group had a significantly higher incidence of depressed neonates and neonatal deaths. When accelerations were present, there were significantly fewer depressed infants and neonatal deaths. Overall the perinatal mortality (PNM) was 7.9%; for premature infants it was 27%, postterm 3% and term 1%. There was a 31% incidence of cesarean section. The PNM, when analyzed according to route of delivery, was no different for the very-low-birth-weight, low-birth-weight and term infants. Weight-specific mortality accounted for the apparent difference among the very-low-birth-weight infants. The high incidence and pathophysiology of cord compression (for first- and second-stage labor) may explain the higher incidence of depression in breeches as compared to cephalics. FHR monitoring should be done throughout delivery in order for the physicians to intervene on time when fetal distress is imminent.

Birth Weight↗
PubMedDate not supplied

Painless delivery--a short experience.

PURPOSE: To determine efficacy and safety a randomized comparison of continuous infusion versus intermittent injection of epidural bupivacaine for labor analgesia was performed in the Maternity Hospital, Thapathali Kathmandu. METHODS: Twenty healthy parturient received a loading dose of 10 ml of epidural 0.1% bupivacaine with 25 mg of pethidine. They were then randomized to receive continuous infusion of 0.1% bupivacaine 10 ml/hour with the help of infusion pump or intermittent injection of 0.1% bupivacaine 10 ml hourly. For breakthrough pain 10 ml of 0.1% bupivacaine top ups given in both groups. The two groups were compared for analgesic efficacy, mode of delivery, patient assessment of analgesia, motor block and other complications. Data analyzed in Pentium III version with SPSS and statistical significance test is done with independent samples t-test. RESULTS: The 10 patients in each group were comparable in age but not in parity. Analgesic efficacy was excellent in 10 cases and comfortable in another 10 cases [excellent/comfortable 6:4 with infusion and 4:6 with intermittent injection]. There were no statistically significant differences between groups in pain scores or duration of active first or second stage of labor. Fifteen women had spontaneous vaginal deliveries, one caesarian section (infusion group) and four instrumental deliveries (intermittent injection group). Four women in the infusion group had hypotension and motor block, but none in the intermittent injection group. APGAR scores in both groups were 7-8/10 at 1 minute and 9-10/10 at 5 minutes. CONCLUSION: Both continuous infusion and intermittent injection of low dose bupivacaine are very good methods of relieving labor pain in our context. Analgesic efficacy was similar in both groups and there was no prolongation of second stage of labor.

Adult↗
PubMed2004

Labor analgesia and cesarean delivery: an individual patient meta-analysis of nulliparous women.

BACKGROUND: The authors performed an individual patient meta-analysis of 2,703 nulliparous women who were randomized to either epidural analgesia or intravenous opioids for pain relief during labor from five trials conducted at their hospital. The primary purpose in this meta-analysis was to evaluate the effects of epidural analgesia during labor on the rate of cesarean delivery. METHODS: Between November 1, 1993, and November 3, 2000, 2,703 nulliparous women (2,188 healthy parturients and 515 women with pregnancy-induced hypertension) in spontaneous labor at term were randomized to receive either epidural analgesia or intravenous opioid analgesia in the five studies. Epidural analgesia was initiated with either epidural bupivacaine or intrathecal sufentanil and was maintained with a low-dose (0.0625% or 0.125%) mixture of bupivacaine with fentanyl. Intravenous opioid analgesia was initiated with 50 mg meperidine and 25 mg promethazine hydrochloride and was maintained with intravenous boluses of meperidine as needed. RESULTS: A total of 1,339 nulliparous women were randomized to receive epidural analgesia, and 1,364 women were randomized to receive intravenous meperidine analgesia. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 10.5% [140 of 1,339] vs. intravenous meperidine analgesia, 10.3% [141 of 1,364]; adjusted odds ratio, 1.04; 95% confidence interval, 0.81-1.34; P = 0.920). Significantly more women randomized to epidural analgesia had forceps deliveries compared to meperidine analgesia (13% [172 of 1,339] vs. 7% [101 of 1,364]; adjusted odds ratio, 1.86; 95% confidence interval, 1.43-2.40; P < 0.001). Epidural women had longer first and second stages of labor. Women who received epidural analgesia reported lower pain scores during labor and delivery compared to women who received intravenous meperidine analgesia. CONCLUSION: Epidural analgesia compared to intravenous meperidine analgesia during labor does not increase the number of cesarean deliveries.

Adult↗
PubMed2002

Ripening of the uterine cervix in a post-cesarean parturient: prostaglandin E2 versus Foley catheter.

OBJECTIVE: To compare the success and complication rates of prostaglandin E2 tablets (PGE2) and a Foley catheter for the ripening of the uterine cervix in post-Cesarean section parturients. STUDY DESIGN: The study population in this retrospective cohort study consisted of parturients in their second pregnancy who had undergone Cesarean section in their previous delivery and who underwent ripening of the uterine cervix by using PGE2 (n = 55) or Foley catheter (n = 161) in the current pregnancy. The control group consisted of 1432 post-Cesarean section parturients without induction of labor. We compared the rates of placental abruption, non-reassuring fetal heart rate patterns, intrapartum fetal deaths (IPFD), uterine rupture, Apgar scores, labor dystocia, severe birth canal lacerations, vacuum deliveries and repeated Cesarean section rates in the three groups by using ANOVA, chi2 analysis and Fisher's exact test when appropriate. RESULTS: A significant increase in the rates of labor dystocia during the first stage (30.4% vs. 11.6%, p < 0.01) and repeated Cesarean deliveries (49.1% vs. 35.2%, p < 0.01) were observed in women in whom the Foley catheter was used as compared to controls, respectively. No such changes were demonstrated in the PGE2 group as compared to the controls. No significant differences were found between the PGE2 group and Foley catheter group as compared to the controls in rates of placental abruption, IPFD, uterine rupture, fetal distress, birth canal lacerations, vacuum deliveries and Apgar scores. CONCLUSIONS: PGE2 was found to be superior to the Foley catheter for ripening of the uterine cervix in a post-Cesarean parturient, as demonstrated by a lower repeated Cesarean delivery rate.

Adult↗
PubMed1989

The effects of the upright position during childbirth.

The purpose of this investigation was to replicate an earlier study to clarify and verify its findings. The 68, term primigravidae married women between the ages of 18 and 25 years were assigned to three groups: (a) one group used a 30 degree upright position with no bearing down instructions during the second stage of labor (n = 24); (b) the second group used a 30 degree upright position with bearing down instructions given during the second stage of labor (n = 22); and (c) a control group used a zero degree recumbent position with bearing down instructions during the second stage of labor (n = 22). The upright position enhanced the descent of the fetal head with a shorter duration of labor in both the first and second stages. When mothers in an upright position were left alone to bear down in response to their own bodies' urges, the second stage of labor was of shorter duration.

Adolescent↗
PubMed2005

Maternal morbidity associated with obstetrical maneuvers in shoulder dystocia.

OBJECTIVES: To determine whether shoulder dystocia and obstetrical maneuvers used for its relief have detrimental effects on perineum or immediate postpartum outcome. DESIGN: Case-control study. SETTING: Tertiary maternity ward in Marseille, France. POPULATION: A total 140 cases with shoulder dystocia and 280 controls without shoulder dystocia were enrolled by reviewing charts for the period between January 1999 and December 2004. METHODS: Demographic data including obstetrical history, age, height, weight before pregnancy and at the time of delivery, and respective body mass index (BMI) and obstetrical data including analgesic technique, duration of first and second stage of labor were compared in function of outcome and of the type and number of maneuvers used to relieve shoulder dystocia. RESULTS: Resolving shoulder dystocia required one obstetrical maneuver in 41 cases (29.3%) and two obstetrical maneuvers in 48 cases (34.3%). Third-degree tears occurred in one patient in the case group versus five in the control group. No correlation was found between the number of obstetrical maneuvers needed to relieve shoulder dystocia and risk for third-degree tear (OR: 0.8; 95% CI: 0.1-7.6). Mean hemoglobin values were 96.1 g/l in the case group and 96.0 g/l in the control group (p=0.95). There was no difference between the two groups regarding duration of postpartum hospitalization. The incidence of urinary incontinence was similar in the group that underwent obstetrical maneuvers: 4.7% (6/127) and in the control group: 3.7% (13/352). Only two patients reported de novo anal symptoms, both in the control group. CONCLUSION: Shoulder dystocia and obstetrical techniques used for its relief did not result in adverse maternal outcome.

Adult↗
PubMed1997

Vacuum extraction: does duration predict scalp injury?

OBJECTIVE: To identify variables that increase the chance of neonatal scalp injury during vacuum extraction. METHODS: We conducted a prospective observational study of 134 vacuum extraction-assisted deliveries at Olive View-UCLA Medical Center in 1995. Data collected included parity, gestational age, duration of first and second stages of labor, indication for operative delivery, station and position of fetal head, duration of vacuum application, number of "pop-offs," neonatal weight, and descriptions of scalp marks or injury. Cranial imaging studies were obtained if clinically indicated. RESULTS: There were 28 infants with scalp trauma, including 17 superficial lacerations, six large caputs, and 12 cephalohematomata; one infant had subgaleal, subdural, and subarachnoid hemorrhages. Logistic regression analysis showed duration of vacuum application to be the best predictor of scalp injury, followed by duration of second stage of labor and paramedian cup placement. Duration of vacuum application ranged from 0.5 to 26 minutes, with a median length of 3 minutes. The proportion of injuries was greater for applications exceeding 10 minutes (6 of 9) than for those 10 minutes or shorter (22 of 121, P < .01). We did not encounter any cases of clinically important scalp injury. CONCLUSIONS: Cosmetic scalp trauma occurred in 21% of our newborns delivered by vacuum extraction and was more common after longer vacuum applications, longer second stages, and paramedian cup placement.

Adolescent↗