{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:04:36Z","timestamp":1790291076296,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,1,23]],"date-time":"2019-01-23T00:00:00Z","timestamp":1548201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The association between vacuum extraction and intracranial hemorrhage has been debated. We sought to investigate the impact of protracted vacuum extraction on the risk for neonatal intracranial hemorrhage in term infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>This nationwide case\u2010control study covered Swedish maternity wards from 1999 to 2013. All term, live\u2010born infants diagnosed with neonatal intracranial hemorrhage after vacuum\u2010assisted delivery were included as cases (n\u00a0=\u00a0167). For each case, 3 vacuum\u2010delivered controls, without a diagnosis for intracranial hemorrhage, were selected (n\u00a0=\u00a0546 controls). Conditional logistic regression analysis was used to study the association between protracted extraction (defined as vacuum duration &gt;\u00a015\u00a0min, &gt;\u00a06 pulls or &gt;\u00a02 cup detachments), and neonatal intracranial hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Extractions exceeded 15\u00a0min among 33% of the cases, vs 5% of the controls. More than six pulls were used in 25% of the cases and in 4% of the controls, and more than two cup detachments occurred in 3.6% of the cases and in 0.6% of the controls. Compared with extractions adhering to safety recommendations, the odds for intracranial hemorrhage were nine\u2010fold (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 8.91, 95%, <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 5.22\u201015.20) among infants exposed to a protracted extraction. After adjustments for potential confounders, the <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> decreased to 8.04 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 4.49\u201014.38).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The strong association between protracted extraction and intracranial hemorrhage suggests that adherence to safety recommendations may reduce the risk for intracranial hemorrhage in infants delivered by vacuum extraction. However, safe limits for vacuum duration and number of pulls are still unknown and intracranial hemorrhage may occur even when performed in accordance with safety recommendations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13519","type":"journal-article","created":{"date-parts":[[2018,12,22]],"date-time":"2018-12-22T05:21:30Z","timestamp":1545456090000},"page":"523-532","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Protracted vacuum extraction and neonatal intracranial hemorrhage among infants born at term: a nationwide case\u2010control study"],"prefix":"10.1111","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9122-9860","authenticated-orcid":false,"given":"Katarina","family":"\u00c5berg","sequence":"first","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health Division of Reproductive Health Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Pettersson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"J\u00e4rnbert\u2010Pettersson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education S\u00f6dersjukhuset Hospital Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5861-4692","authenticated-orcid":false,"given":"Cecilia","family":"Ek\u00e9us","sequence":"additional","affiliation":[{"name":"Department of Women\u2032s and Children\u2032s Health Division of Reproductive Health Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,1,23]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-010-0698-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073812446162"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-36"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.2.103"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2008.09.019"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412301"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.13274"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000047819.33177.72"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/hae.12726"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2014.01.054"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-015-0415-7"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15730-9"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117309"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000050403"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3182749ac9"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14820"},{"issue":"1","key":"e_1_2_9_18_1","doi-asserted-by":"crossref","first-page":"S230","DOI":"10.1007\/BF03545639","article-title":"Tentorial hemorrhage associated with vacuum extraction in a newborn","volume":"25","author":"Huang LT","year":"1995","journal-title":"Pediatr Radiol"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211845"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.13557"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/beog.2001.0252"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0965539506001823"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2007.03.006"},{"key":"e_1_2_9_24_1","unstructured":"Vladic\u2010StjernholmY WM AhlbergM Amer\u2010W\u00e5hlinI.Instrumental delivery by vacuum extraction: advice for clinical recommendations (In Swedish).Safe delivery. 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