A neonate delivered with vacuum assistance may develop a number of complications. Fortunately these are usually rare.


Indications for vacuum-assisted delivery include one or more of the following:

(1) prolonged second stage of labor

(2) fetal distress

(3) malposition of the vertex


Common complications with no clinical significance:

(1) cephalohematoma

(2) nondepressed skull fracture

(3) scalp edema (including caput succedaneum) and/or bruising

(4) retinal hemorrhage


Rare complications that may be serious:

(1) depressed skull fracture

(2) intracranial hemorrhage

(3) subgaleal hemorrhage (below the galea aponeurotica)


Risk factors for complications:

(1) nulliparity of mother

(2) vacuum attempt at mid-station

(3) 4 or more tractions required for extraction

(4) dislodgment of the cup


These risk factors are sensitive but nonspecific (they have a low predictive value).


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