{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:13:56Z","timestamp":1787015636092,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT\u2010162300"],"award-info":[{"award-number":["PJT\u2010162300"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a population\u2010based observational study of 1\u2009080\u2009503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80\u20133.16) and forceps (RR 3.35, 95% CI 3.07\u20133.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1\u201326.6) and brain and spinal damage (RR 13.5, 95% CI 5.72\u201332.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8\u201336.4) and skull fractures (RR 2.04, 95% CI 1.86\u20132.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.15801","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T06:16:01Z","timestamp":1695968161000},"page":"2817-2824","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery"],"prefix":"10.1111","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-0459","authenticated-orcid":false,"given":"Nathalie","family":"Auger","sequence":"first","affiliation":[{"name":"University of Montreal Hospital Research Centre  Montreal Quebec Canada"},{"name":"Institut national de sant\u00e9 publique du Qu\u00e9bec  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu Qin","family":"Wei","sequence":"additional","affiliation":[{"name":"Institut national de sant\u00e9 publique du Qu\u00e9bec  Montreal Quebec Canada"},{"name":"Department of Obstetrics and Gynecology University of Montreal  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimina","family":"Ayoub","sequence":"additional","affiliation":[{"name":"University of Montreal Hospital Research Centre  Montreal Quebec Canada"},{"name":"Institut national de sant\u00e9 publique du Qu\u00e9bec  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thuy Mai","family":"Luu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Sainte\u2010Justine Hospital Research Centre University of Montreal  Montreal Quebec 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