Loading…

Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study

Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long‐term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long‐term morbidity. The aim of this study w...

Full description

Saved in:
Bibliographic Details
Published in:Acta obstetricia et gynecologica Scandinavica 2023-07, Vol.102 (7), p.843-853
Main Authors: Ulfsdottir, Hanna, Ekéus, Cecilia, Tedroff, Kristina, Åberg, Katarina, Järnbert‐Pettersson, Hans
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c5338-39847f7af226376cf55c4337f0a8aa856940a3623064aae538002afd43b069b83
container_end_page 853
container_issue 7
container_start_page 843
container_title Acta obstetricia et gynecologica Scandinavica
container_volume 102
creator Ulfsdottir, Hanna
Ekéus, Cecilia
Tedroff, Kristina
Åberg, Katarina
Järnbert‐Pettersson, Hans
description Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long‐term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long‐term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long‐term perspective. Material and methods The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow‐up time was from birth until December 31, 2019. Results The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33–3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS. Conclusions The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS. This national cohort study of 1.5 million children planned for a vaginal birth investigates the risk of neonatal mortality, cerebral palsy, and epilepsy among children delivered by vacuum extraction in a long‐term perspective.Our results indicate that VE is a safe obstetric intervention concerning the studied outcomes, however, it implies a thorough risk assessment.
doi_str_mv 10.1111/aogs.14568
format article
fullrecord <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_446679</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2796160663</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5338-39847f7af226376cf55c4337f0a8aa856940a3623064aae538002afd43b069b83</originalsourceid><addsrcrecordid>eNp9kstu1DAUhiMEokNhwwMgS2wQIsV3Oys0KlCQRuqCy9ZyHGfGJYkHO56SHY_AM_IkeMi0UKTijX3s7_w-x_6L4jGCJyiPl9qv4wmijMs7xQJxCEtIEb5bLCCEqOSEVkfFgxgvcoQFlfeLIyIgEhUWi6Jb-WH98_uP0YYeDDYF3_m1M7oDvQ-1a9w4Ad1nBpiN65pgB9DYzu1ssA2oJ7DTJqUe2G9j0GZ0fgBZDGgw6H2QZYzf-DCCOKZmeljca3UX7aPDfFx8evvm4-m7cnV-9v50uSoNI0SWpJJUtEK3GHMiuGkZM5QQ0UIttZaMVxRqwjGBnGptGZEQYt02lNSQV7Ukx0U568ZLu0212gbX6zApr506bH3JK6so5VxUma9u5bfBN3-SrhIRwxRyJHnOfXFr7mv3eal8WKuUFEO5G5bxVzOe2d42xg754bqbN944GdxGrf1OIUgI4Xzf3LODQvBfk42j6l00tuv0YH2KCouKZxNwTjL69B_0wqeQfyVTkuS3FpjhTD2fKRN8jMG219UgqPYGU3uDqd8Gy_CTv-u_Rq8clQE0A5eus9N_pNTy_OzDLPoLO_Hf2Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2835337252</pqid></control><display><type>article</type><title>Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study</title><source>Wiley Online Library Open Access</source><source>PubMed Central (Training)</source><creator>Ulfsdottir, Hanna ; Ekéus, Cecilia ; Tedroff, Kristina ; Åberg, Katarina ; Järnbert‐Pettersson, Hans</creator><creatorcontrib>Ulfsdottir, Hanna ; Ekéus, Cecilia ; Tedroff, Kristina ; Åberg, Katarina ; Järnbert‐Pettersson, Hans</creatorcontrib><description>Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long‐term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long‐term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long‐term perspective. Material and methods The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow‐up time was from birth until December 31, 2019. Results The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33–3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS. Conclusions The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS. This national cohort study of 1.5 million children planned for a vaginal birth investigates the risk of neonatal mortality, cerebral palsy, and epilepsy among children delivered by vacuum extraction in a long‐term perspective.Our results indicate that VE is a safe obstetric intervention concerning the studied outcomes, however, it implies a thorough risk assessment.</description><identifier>ISSN: 0001-6349</identifier><identifier>ISSN: 1600-0412</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.14568</identifier><identifier>PMID: 37017927</identifier><language>eng</language><publisher>United States: John Wiley &amp; Sons, Inc</publisher><subject>Birth ; Cerebral palsy ; Cerebral Palsy - epidemiology ; Cerebral Palsy - etiology ; Cesarean Section ; Child ; Childbirth &amp; labor ; Cohort analysis ; Cohort Studies ; emergency cesarean section ; Epilepsy ; Female ; Humans ; Infant Mortality ; Infant, Newborn ; Medicin och hälsovetenskap ; Morbidity ; neonatal death ; Newborn babies ; Original ; Perinatal Death - etiology ; Pregnancy ; spontaneous vaginal birth ; vacuum extraction ; Vacuum Extraction, Obstetrical - adverse effects ; Vagina</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2023-07, Vol.102 (7), p.843-853</ispartof><rights>2023 The Authors. published by John Wiley &amp; Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).</rights><rights>2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley &amp; Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c5338-39847f7af226376cf55c4337f0a8aa856940a3623064aae538002afd43b069b83</cites><orcidid>0000-0001-9122-9860 ; 0000-0002-9718-754X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333668/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333668/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,11562,27924,27925,46052,46476,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37017927$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-512265$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:152406186$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Ulfsdottir, Hanna</creatorcontrib><creatorcontrib>Ekéus, Cecilia</creatorcontrib><creatorcontrib>Tedroff, Kristina</creatorcontrib><creatorcontrib>Åberg, Katarina</creatorcontrib><creatorcontrib>Järnbert‐Pettersson, Hans</creatorcontrib><title>Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long‐term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long‐term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long‐term perspective. Material and methods The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow‐up time was from birth until December 31, 2019. Results The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33–3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS. Conclusions The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS. This national cohort study of 1.5 million children planned for a vaginal birth investigates the risk of neonatal mortality, cerebral palsy, and epilepsy among children delivered by vacuum extraction in a long‐term perspective.Our results indicate that VE is a safe obstetric intervention concerning the studied outcomes, however, it implies a thorough risk assessment.</description><subject>Birth</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - epidemiology</subject><subject>Cerebral Palsy - etiology</subject><subject>Cesarean Section</subject><subject>Child</subject><subject>Childbirth &amp; labor</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>emergency cesarean section</subject><subject>Epilepsy</subject><subject>Female</subject><subject>Humans</subject><subject>Infant Mortality</subject><subject>Infant, Newborn</subject><subject>Medicin och hälsovetenskap</subject><subject>Morbidity</subject><subject>neonatal death</subject><subject>Newborn babies</subject><subject>Original</subject><subject>Perinatal Death - etiology</subject><subject>Pregnancy</subject><subject>spontaneous vaginal birth</subject><subject>vacuum extraction</subject><subject>Vacuum Extraction, Obstetrical - adverse effects</subject><subject>Vagina</subject><issn>0001-6349</issn><issn>1600-0412</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp9kstu1DAUhiMEokNhwwMgS2wQIsV3Oys0KlCQRuqCy9ZyHGfGJYkHO56SHY_AM_IkeMi0UKTijX3s7_w-x_6L4jGCJyiPl9qv4wmijMs7xQJxCEtIEb5bLCCEqOSEVkfFgxgvcoQFlfeLIyIgEhUWi6Jb-WH98_uP0YYeDDYF3_m1M7oDvQ-1a9w4Ad1nBpiN65pgB9DYzu1ssA2oJ7DTJqUe2G9j0GZ0fgBZDGgw6H2QZYzf-DCCOKZmeljca3UX7aPDfFx8evvm4-m7cnV-9v50uSoNI0SWpJJUtEK3GHMiuGkZM5QQ0UIttZaMVxRqwjGBnGptGZEQYt02lNSQV7Ukx0U568ZLu0212gbX6zApr506bH3JK6so5VxUma9u5bfBN3-SrhIRwxRyJHnOfXFr7mv3eal8WKuUFEO5G5bxVzOe2d42xg754bqbN944GdxGrf1OIUgI4Xzf3LODQvBfk42j6l00tuv0YH2KCouKZxNwTjL69B_0wqeQfyVTkuS3FpjhTD2fKRN8jMG219UgqPYGU3uDqd8Gy_CTv-u_Rq8clQE0A5eus9N_pNTy_OzDLPoLO_Hf2Q</recordid><startdate>202307</startdate><enddate>202307</enddate><creator>Ulfsdottir, Hanna</creator><creator>Ekéus, Cecilia</creator><creator>Tedroff, Kristina</creator><creator>Åberg, Katarina</creator><creator>Järnbert‐Pettersson, Hans</creator><general>John Wiley &amp; Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><scope>ACNBI</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DF2</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-9122-9860</orcidid><orcidid>https://orcid.org/0000-0002-9718-754X</orcidid></search><sort><creationdate>202307</creationdate><title>Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study</title><author>Ulfsdottir, Hanna ; Ekéus, Cecilia ; Tedroff, Kristina ; Åberg, Katarina ; Järnbert‐Pettersson, Hans</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5338-39847f7af226376cf55c4337f0a8aa856940a3623064aae538002afd43b069b83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Birth</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - epidemiology</topic><topic>Cerebral Palsy - etiology</topic><topic>Cesarean Section</topic><topic>Child</topic><topic>Childbirth &amp; labor</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>emergency cesarean section</topic><topic>Epilepsy</topic><topic>Female</topic><topic>Humans</topic><topic>Infant Mortality</topic><topic>Infant, Newborn</topic><topic>Medicin och hälsovetenskap</topic><topic>Morbidity</topic><topic>neonatal death</topic><topic>Newborn babies</topic><topic>Original</topic><topic>Perinatal Death - etiology</topic><topic>Pregnancy</topic><topic>spontaneous vaginal birth</topic><topic>vacuum extraction</topic><topic>Vacuum Extraction, Obstetrical - adverse effects</topic><topic>Vagina</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ulfsdottir, Hanna</creatorcontrib><creatorcontrib>Ekéus, Cecilia</creatorcontrib><creatorcontrib>Tedroff, Kristina</creatorcontrib><creatorcontrib>Åberg, Katarina</creatorcontrib><creatorcontrib>Järnbert‐Pettersson, Hans</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Online Library Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Uppsala universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Uppsala universitet</collection><collection>SwePub Articles full text</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ulfsdottir, Hanna</au><au>Ekéus, Cecilia</au><au>Tedroff, Kristina</au><au>Åberg, Katarina</au><au>Järnbert‐Pettersson, Hans</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2023-07</date><risdate>2023</risdate><volume>102</volume><issue>7</issue><spage>843</spage><epage>853</epage><pages>843-853</pages><issn>0001-6349</issn><issn>1600-0412</issn><eissn>1600-0412</eissn><abstract>Introduction This is the first nationwide cohort study of vacuum extraction (VE) and long‐term neurological morbidity. We hypothesized that VE per se, and not only complicated labor, can cause intracranial bleedings, which could further cause neurological long‐term morbidity. The aim of this study was to investigate the risk of neonatal mortality, cerebral palsy (CP), and epilepsy among children delivered by VE in a long‐term perspective. Material and methods The study population included 1 509 589 term singleton children planned for vaginal birth in Sweden (January 1, 1999 to December 31, 2017). We investigated the risk of neonatal death (ND), CP, and epilepsy among children delivered by VE (successful or failed) and compared their risks with those born by spontaneous vaginal birth and emergency cesarean section (ECS). We used logistic regression to study the adjusted associations with each outcome. The follow‐up time was from birth until December 31, 2019. Results The percentage and total number of children with the outcomes were ND (0.04%, n = 616), CP (0.12%, n = 1822), and epilepsy (0.74%, n = 11 190). Compared with children delivered by ECS, those born by VE had no increased risk of ND, but there was an increased risk for those born after failed VE (adj OR 2.23 [1.33–3.72]). The risk of CP was similar among children born by VE and those born spontaneously vaginally. Further, the risk of CP was similar among children born after failed VE compared with ECS. The risk of epilepsy was not increased among children born by VE (successful/failed), compared with those who had spontaneous vaginal birth or ECS. Conclusions The outcomes ND, CP, and epilepsy are rare. In this nationwide cohort study, children born after successful VE had no increased risk of ND, CP or epilepsy compared with those delivered by ECS, but there was an increased risk of ND among those born by failed VE. Concerning the studied outcomes, VE appears to be a safe obstetric intervention; however, it requires a thorough risk assessment and awareness of when to convert to ECS. This national cohort study of 1.5 million children planned for a vaginal birth investigates the risk of neonatal mortality, cerebral palsy, and epilepsy among children delivered by vacuum extraction in a long‐term perspective.Our results indicate that VE is a safe obstetric intervention concerning the studied outcomes, however, it implies a thorough risk assessment.</abstract><cop>United States</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>37017927</pmid><doi>10.1111/aogs.14568</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9122-9860</orcidid><orcidid>https://orcid.org/0000-0002-9718-754X</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0001-6349
ispartof Acta obstetricia et gynecologica Scandinavica, 2023-07, Vol.102 (7), p.843-853
issn 0001-6349
1600-0412
1600-0412
language eng
recordid cdi_swepub_primary_oai_swepub_ki_se_446679
source Wiley Online Library Open Access; PubMed Central (Training)
subjects Birth
Cerebral palsy
Cerebral Palsy - epidemiology
Cerebral Palsy - etiology
Cesarean Section
Child
Childbirth & labor
Cohort analysis
Cohort Studies
emergency cesarean section
Epilepsy
Female
Humans
Infant Mortality
Infant, Newborn
Medicin och hälsovetenskap
Morbidity
neonatal death
Newborn babies
Original
Perinatal Death - etiology
Pregnancy
spontaneous vaginal birth
vacuum extraction
Vacuum Extraction, Obstetrical - adverse effects
Vagina
title Long‐term neurological morbidity among children delivered by vacuum extraction ‐ a national cohort study
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T14%3A26%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Long%E2%80%90term%20neurological%20morbidity%20among%20children%20delivered%20by%20vacuum%20extraction%20%E2%80%90%20a%20national%20cohort%20study&rft.jtitle=Acta%20obstetricia%20et%20gynecologica%20Scandinavica&rft.au=Ulfsdottir,%20Hanna&rft.date=2023-07&rft.volume=102&rft.issue=7&rft.spage=843&rft.epage=853&rft.pages=843-853&rft.issn=0001-6349&rft.eissn=1600-0412&rft_id=info:doi/10.1111/aogs.14568&rft_dat=%3Cproquest_swepu%3E2796160663%3C/proquest_swepu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c5338-39847f7af226376cf55c4337f0a8aa856940a3623064aae538002afd43b069b83%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2835337252&rft_id=info:pmid/37017927&rfr_iscdi=true