{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T23:04:35Z","timestamp":1790291075984,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,9,9]],"date-time":"2020-09-09T00:00:00Z","timestamp":1599609600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004348","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["108182"],"award-info":[{"award-number":["108182"]}],"id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004348","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","award":["551176"],"award-info":[{"award-number":["551176"]}],"id":[{"id":"10.13039\/501100004348","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":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Traction force is a possible risk factor for adverse neonatal outcome in vacuum extraction delivery, but the knowledge is scarce and further investigation is needed. Our hypothesis was that high\u2010level traction force increases the risk of admission to the neonatal intensive care unit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>The study was a hospital\u2010based prospective cohort study on low\u2010 and mid\u2010vacuum extractions at the labor and delivery ward, Karolinska University Hospital, Huddinge, Sweden. Traction forces were measured in 331 women. An electronical handle was used to measure and register traction force. The main exposure variable was high\u2010level traction force (\u226575th percentile) during the first three pulls and the primary outcome was admission to the neonatal intensive care unit. Logistic regression was used to estimate the adjusted risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the exposed, 14\/84 (16.7%) were admitted to neonatal intensive care, and among the unexposed 10\/247 (4%). The crude odds ratio (OR) of admission to the neonatal intensive care unit when exposed to high\u2010level traction force was 4.7, and the adjusted (birthweight, gestational length, cup detachment, number of pulls, duration, duration &gt;15\u00a0minutes, mid\u2010cavity fetal head station, failed extraction, indication and parity) OR was 2.85 (95% confidence interval [CI] 1.09\u20107.48). No significant effect was seen in Apgar\u00a0scores &lt;7 at 5\u00a0minutes or pH\u00a0&lt;7.1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High\u2010level traction force may be a risk factor for neonatal complications. Although these results do not mandate any alterations in clinical guidelines, perioperative feedback on traction force may be useful to alert the obstetrician to a timely conversion to cesarean section. To study plausible traction force specific outcomes such as head traumas, a larger sample size is required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13952","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T15:04:52Z","timestamp":1594307092000},"page":"1710-1716","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association of traction force and adverse neonatal outcome in vacuum\u2010assisted vaginal delivery: A prospective cohort study"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4603-2310","authenticated-orcid":false,"given":"Kristina A.","family":"Pettersson","sequence":"first","affiliation":[{"name":"Children and Women\u2019s Health Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Obstetrics and Gynecology Clintec Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Westgren","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Clintec Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Blennow","sequence":"additional","affiliation":[{"name":"Children and Women\u2019s Health Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Pediatrics Clintec Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunilla","family":"Ajne","sequence":"additional","affiliation":[{"name":"Children and Women\u2019s Health Karolinska University Hospital Stockholm Sweden"},{"name":"Department of Obstetrics and Gynecology Clintec Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199912023412301"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15730-9"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31823835d3"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1980.03310140055031"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-923438"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.gco.0000192983.76976.68"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.12698"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-0511"},{"key":"e_1_2_10_10_1","first-page":"299","article-title":"A comparison of different methods of instrumental delivery based on electronic measurements of compression and traction","volume":"54","author":"Moolgaoker AS","year":"1979","journal-title":"Obstet Gynecol"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016345709156821"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1964.tb04330.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e31811eaa39"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001147"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-016-4206-7"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-36"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.11.007"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1973.1.4.245"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016348709083041"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13222"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(87)90044-X"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2006.00540.x"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)32890-0"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0033-1360343"},{"key":"e_1_2_10_25_1","unstructured":"Vladic\u2010StjernholmYWMAM Amer\u2010Wh\u00e5linI.Instrumental delivery by vacuum extraction: advice for clinical recommendations(in Swedish). 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