Vacuum extraction failure is associated with a large head circumference

Doron Kabiri, Michal Lipschuetz, Sarah M. Cohen, Oren Yagel, Lorinne Levitt, Shmuel Herzberg, Yossef Ezra, Simcha Yagel, Hagai Amsalem

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective: To determine whether large head circumference increases the risk of vacuum extraction failure. Study design: This EMR-based study included all attempted vacuum extractions performed in a tertiary center between January 2010 and June 2015. All term singleton live births were eligible. Cases were divided into four groups: head circumference ≥90th percentile both with birth weight ≥90th percentile and <90th percentile and fetal head circumference <90th percentile with birth weight ≥90th and <90th percentile. Risk of failed vacuum extraction was compared among these groups. Other neonatal and maternal parameters were also evaluated as potential risk factors. Multinomial multivariable regression provided adjusted odds ratio for vacuum extraction failure while controlling for potential confounders. Results: During the study period, 48,007 deliveries met inclusion criteria, of which 3835 had an attempt at vacuum extraction. We identified 215 (5.6%) cases of vacuum extraction failure. The adjusted odds ratios (aOR) for vacuum extraction failure in cases of large fetal head circumference was 2.31 (95%CI, 1.7–3.15, p <.001). Primiparity, prolonged second stage and occipito-posterior presentation were also found to be significant risk factors for failed vacuum extraction. Comments: In this study, we found that large head circumference was associated with vacuum extraction failure rather than high birth weight.

Original languageEnglish
Pages (from-to)3325-3330
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number20
StatePublished - 18 Oct 2019

Bibliographical note

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© 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.


  • Birth-weight
  • FHC
  • head circumference
  • instrumental delivery
  • vacuum extraction


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