{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T01:50:36Z","timestamp":1769910636504,"version":"3.49.0"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"03","funder":[{"name":"NIHCD","award":["K12 HD050121-09"],"award-info":[{"award-number":["K12 HD050121-09"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:p>\n            Objective\u2003Obstetrical vacuum manufacturers have long recommended a maximum of two to three pop-offs be allowed before abandoning the procedure. However, there is a paucity of evidence on the safety of vacuum-assisted vaginal delivery in relation to the number of pop-offs to support this recommendation. Our objective was to examine whether the number of pop-offs in a vacuum-assisted vaginal delivery was associated with adverse neonatal outcomes.<\/jats:p><jats:p>\n            Study Design\u2003This is a retrospective cohort study of women who underwent a trial of a vacuum-assisted vaginal delivery at a single tertiary care institution between October 2005 and June 2014. Maternal and fetal factors associated with the number of pop-offs were examined in bivariable analyses. Multivariable analyses were performed to determine the independent association of the number of pop-offs with adverse neonatal outcomes.<\/jats:p><jats:p>\n            Results\u2003Of the 1,730 women who met inclusion criteria, 1,293 (74.7%) had no pop-offs, 240 (13.9%) had one pop-off, 128 (7.4%) had two pop-offs, and 69 (4.0%) had three or more pop-offs. Neonatal scalp\/facial lacerations, intracranial hemorrhage, seizures, central nervous system depression, and neonatal intensive care unit admission were all associated with the number of pop-offs in bivariable analyses. In multivariable analyses, compared to no pop-offs, having any vacuum pop-offs was associated with an increased odds of adverse neonatal outcomes. However, there was not a consistent dose\u2013response relationship.<\/jats:p><jats:p>\n            Conclusion\u2003While having vacuum pop-offs in a vacuum-assisted vaginal delivery was associated with an increased risk of adverse neonatal outcomes, there did not appear to be a dose-dependent association with the number of pop-offs.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0041-1728824","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T22:52:08Z","timestamp":1620082328000},"page":"274-278","source":"Crossref","is-referenced-by-count":4,"title":["The Association between the Number of Vacuum Pop-Offs and Adverse Neonatal Outcomes"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7794-0581","authenticated-orcid":false,"given":"Allie","family":"Sakowicz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salwa J.","family":"Zahalka","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily S.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"issue":"01","key":"ref1","first-page":"5","article-title":"Vacuum-assisted vaginal delivery","volume":"2","author":"U A Ali","year":"2009","journal-title":"Rev Obstet 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pulls, cup detachments, and duration of vacuum application?","volume":"295","author":"A Ghidini","year":"2017","journal-title":"Arch Gynecol Obstet"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1097\/AOG.0000000000003764","article-title":"Practice Bulletin No. 219: Operative vaginal birth","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/01.AOG.0000255981.86303.2b","article-title":"Neonatal complications of vacuum-assisted delivery","volume":"109","author":"C Simonson","year":"2007","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00404-017-4507-5","article-title":"Cup detachment during vacuum-assisted vaginal delivery and birth outcome","volume":"296","author":"E Krispin","year":"2017","journal-title":"Arch 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extractor","volume":"27","author":"M A Castro","year":"2003","journal-title":"Semin Perinatol"}],"container-title":["American Journal of 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