NEONATAL CEPHALHEMATOMA FROM VACUUM EXTRACTION

OBJECTIVE: To identify factors involved in the development of fetal ce phalohematoma from vacuum extraction. STUDY DESIGN: Patients at greate r than or equal to 34 weeks' gestation were randomly assigned to deliv ery by vacuum (n=322) using the continuous (n= 164) or intermittent (n = 158) technique. Neonatal outcome with cephalohematoma was analyzed s ubse quently and related to prospectively recorded data. RESULTS: Appr oximately equal numbers of cephalohematoma were recorded in the two gr oups (continuous 20, intermittent 17; P =.686). Station at point of ap plication (P=.008), increasing asynclitism (P <.001) and increasing ap plication to delivery time (P=.002) correlated significantly with ceph alohematoma. Only the last two factors achieved significance after ste pwise multiple logistic regression analysis. Factors that did not achi eve statistical significance were gestational age (P=.755), birth weig ht (P =.982), instrumental rotation (P =.896) and previous vaginal del ivery (P=.051). CONCLUSION: In this prospective, randomized, controlle d trial of vacuum-assisted delivery, the only predelivery factor found to predispose to neonatal cephalohematoma formation was increasing as ynclitism. Although cephalohematoma formation was move likely to devel op as the duration of vacuum application increased during delivery, on ly 28% of neonates exhibited this finding when the time from vacuum ap plication to delivery exceeded five minutes.