OBSTETRIC CORRELATES OF NEONATAL RETINAL HEMORRHAGE

Objective: To determine whether maternal or fetal factors, other than vacuum-assisted delivery, play a role in neonatal retinal hemorrhage, and whether correlates are similar in retinal hemorrhage after spontan eous vaginal delivery. Methods: A cross-section of assisted deliveries at an urban hospital (n = 156) over 7 months were compared with conte mporaneous spontaneous vaginal deliveries (n = 122). A subset of assis ted deliveries (n = 87) was prospectively randomized to forceps or vac uum-assisted delivery by sealed envelope. Maternal and neonatal biomet ric data were collected, and Apgar scores, umbilical artery blood gas analysis, and neonatal ophthalmologic evaluations were performed. Resu lts: Moderate to severe retinal hemorrhage was found in 18% of spontan eous, 13% of forceps, 28% of vacuum-assisted, and 50% of sequential va cuum and forceps-assisted deliveries. Fetal distress (P < .008), vacuu m-assisted delivery (P < .02), decreased birth weight for gestation (P < .004), umbilical artery pH less than 7.20 (P < .004), and second st age of labor less than 30 minutes (P < .05) were most closely associat ed with increased degrees of retinal hemorrhage. Maternal parity, pree clampsia, length of labor, and head circumference were not correlated with retinal hemorrhage. Vacuum-assisted delivery among low birth weig ht infants (P < .0001), short second stage of labor (P < .006), fetal acidosis (P < .045), and sequential use of vacuum and forceps for assi sted delivery (P < .005) formed a logistic model that correctly predic ted 81% of moderate to severe retinal hemorrhage cases. Logistic analy sis of the randomized assisted deliveries gave similar results. Conclu sions: Maternal and fetal factors other than vacuum-assisted delivery are significant correlates of moderate to severe retinal hemorrhage. V acuum-assisted delivery among small for gestational age infants is clo sely correlated with moderate to severe retinal hemorrhage.