Open AccessReason for the increasing use of vacuum extraction in Sweden: a population‐based study
Author(s) -
Elvander Charlotte,
Ekéus Cecilia,
GemzellDanielsson Kristina,
Cnattingius Sven
Publication year - 2013
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12215
Subject(s) - vacuum extraction , medicine , odds ratio , confidence interval , population , gestational age , extraction (chemistry) , fetal distress , obstetrics , pregnancy , demography , fetus , environmental health , chemistry , chromatography , sociology , biology , genetics
Objective To explain the increasing rates of vacuum extraction in Sweden. Design Population‐based register study. Setting Nationwide study in Sweden. Population A total of 589 108 primiparous women with singleton, term live births in 1992–2010. Methods Odds ratios with 95% confidence intervals were estimated for potential risk factors for vacuum extraction and emergency cesarean. To explain the increase in vacuum extraction over time, we successively adjusted for maternal and infant characteristics in four different models. Main outcome measures Vacuum extraction. Results Rates of vacuum extraction increased from 11.5% in 1992 to 14.8% in 2010. The risk of vacuum extraction increased with maternal age and gestational length, but decreased with increasing maternal height. The increased use of vacuum extraction over time was partly explained by increasing maternal age and increased use of epidural anesthesia. Among women with and without epidural analgesia, the increase in vacuum extraction over time was confined to vacuum extraction due to signs of fetal distress. Conclusions Depending on risk factors, the odds of being delivered by vacuum extraction can vary immensely from one woman to another. Increasing maternal age explains a substantial fraction of the increase in vacuum extraction use since 1992. Whether the increase in vacuum extractions due to fetal distress reflects a true increase in fetal distress during labor remains to be explained.