{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T13:51:23Z","timestamp":1769003483290,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T00:00:00Z","timestamp":1652918400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Vacuum\u2010assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C\u2010Obs 16 has not been evaluated to see if advice improves outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim was to evaluate whether compliance with RANZCOG College Statement C\u2010Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.0002), major birth trauma (3% vs 22%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.0001), requirement for neonatal resuscitation (14% vs 35%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.0026) and Apgar scores at one\u00a0minute less than six (5% vs 22% <jats:italic>P<\/jats:italic>\u00a0=\u20090.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388\u2009mL vs 438\u2009mL, <jats:italic>P<\/jats:italic>\u00a0=\u20090.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, <jats:italic>P<\/jats:italic>\u00a0=\u20090.02) and birth requiring instrument change (4% vs 13% <jats:italic>P<\/jats:italic>\u00a0=\u20090.031).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three.<\/jats:p><jats:p>Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13545","type":"journal-article","created":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T09:24:45Z","timestamp":1652952285000},"page":"13-18","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Compliance with clinical guidelines increases the safety of vacuum\u2010assisted delivery"],"prefix":"10.1111","volume":"63","author":[{"given":"Stephen L.Y.","family":"Yim","sequence":"first","affiliation":[{"name":"Northern Beaches Hospital Department of Obstetrics and Gynaecology  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas W.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences &amp; Medicine Bond University  Gold Coast Queensland Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munawwara Talat","family":"Uppal","sequence":"additional","affiliation":[{"name":"Northern Beaches Hospital Department of Obstetrics and Gynaecology  Sydney New South Wales Australia"},{"name":"School of Medicine Sydney University  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4706-2412","authenticated-orcid":false,"given":"Julie\u00a0A.","family":"Quinlivan","sequence":"additional","affiliation":[{"name":"Institute for Health Research University of Notre Dame Australia  Fremantle Western Australia Australia"},{"name":"School of Medicine Australia National University  Canberra Australian Capital Territory Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,19]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"New South Wales Clinical Excellence Commission(2014)CLINICAL FOCUS REPORT Vacuum Assisted Births \u2013 Are We Getting it Right?. Retrieved from:https:\/\/www.cec.health.nsw.gov.au\/__data\/assets\/pdf_file\/0010\/258247\/c\u2010freport\u2010vacuum\u2010assisted\u2010births\u2010are\u2010we\u2010getting\u2010in\u2010right.pdf"},{"key":"e_1_2_6_3_1","unstructured":"Australian Institute of Health and Welfare(2020).Australia's mothers and babies 2018\u2014in brief. Retrieved from:https:\/\/www.aihw.gov.au"},{"key":"e_1_2_6_4_1","unstructured":"New Zealand Minister of Health Publications.Reports on maternity 2017(2019). Retrieved from:https:\/\/www.health.govt.nz\/publication\/reportmaternity\u20102017"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.329.7456.24"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2011.01300.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000255981.86303.2b"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1980.03310140055031"},{"key":"e_1_2_6_9_1","first-page":"24","article-title":"Ecological association between operative vaginal delivery and obstetric and birth trauma","volume":"190","author":"Giulia M","year":"2018","journal-title":"CMAJ"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.4-10-e270"},{"key":"e_1_2_6_11_1","first-page":"207","article-title":"Subaponeurotic haemorrhage in Malaysian neonates","volume":"31","author":"Boo N","year":"1990","journal-title":"Singap Med J"},{"key":"e_1_2_6_12_1","unstructured":"Medical Board of Australia.Obstetrician reprimanded fined and suspended for professional misconduct. (2019). Retrieved from:https:\/\/www.medicalboard.gov.au\/News\/2019\u201001\u201024\u2010obstetricianreprimanded\u2010fined\u2010and\u2010suspended.aspx"},{"key":"e_1_2_6_13_1","unstructured":"Royal Australian and New Zealand College of Obstatricians and Gynaecologists (2020).College statement C\u2010Obs 16. Retrieved from:https:\/\/ranzcog.edu.au\/statements\u2010guidelines"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.10.020"},{"key":"e_1_2_6_15_1","unstructured":"Royal College of Obstetricians and Gynaecologists(2020).Green top guideline no. 26. Retrieved from:https:\/\/www.rcog.org.uk\/en\/guidelines\u2010researchservices\/guidelines\/gtg26\/"},{"key":"e_1_2_6_16_1","unstructured":"Australian Government National Health and Medical Research Council.Ethical Considerations in Quality Assurance and Evaluation Activities. (2014). Retrieved from:https:\/\/www.nhmrc.gov.au\/about\u2010us\/resources\/ethicalconsiderations\u2010qualityassurance\u2010and\u2010evaluation\u2010activities"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1880-4"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00732.x"}],"container-title":["Australian and New Zealand Journal of Obstetrics and Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.13545","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ajo.13545","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.13545","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T15:43:35Z","timestamp":1692287015000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/ajo.13545"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,19]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["10.1111\/ajo.13545"],"URL":"https:\/\/doi.org\/10.1111\/ajo.13545","archive":["Portico"],"relation":{},"ISSN":["0004-8666","1479-828X"],"issn-type":[{"value":"0004-8666","type":"print"},{"value":"1479-828X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,19]]},"assertion":[{"value":"2021-09-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}