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Updated: Aug 6, 2026
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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Long-term neurodevelopmental outcomes after vacuum-assisted delivery: A population-based cohort study
Ida Björk1,2, Jenny Bolk3,4,5, Gunilla Ajne1,2
1Department of CLINTEC, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden.
Plos Medicine
|July 17, 2026
Summary
Vacuum-assisted delivery (VAD) at mid/low fetal head stations increased neonatal risks but not long-term neurodevelopmental disorders. Outlet VAD showed no adverse outcomes, suggesting VAD safety when appropriately used.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Neurodevelopmental Pediatrics
Background:
- Vacuum-assisted delivery (VAD) is a common obstetric procedure.
- Concerns exist regarding potential long-term neurodevelopmental effects in offspring, especially with higher fetal head station VAD.
- Limited evidence exists on long-term outcomes following VAD.
Purpose of the Study:
- To investigate neonatal and long-term neurodevelopmental outcomes after VAD.
- To stratify outcomes based on fetal head station during VAD.
- To compare VAD outcomes with emergency cesarean delivery (ECD) and spontaneous vaginal delivery (SVD).
Main Methods:
- Population-based cohort study using Swedish nationwide health registers (1997-2014 births, follow-up to 2021).
- Included singleton births to primiparous women.
- Multivariable logistic and Cox regression models used to assess neonatal and long-term neurodevelopmental outcomes (ADHD, ASD, CP, epilepsy, intellectual disability), stratified by child sex and adjusted for confounders.
Main Results:
- Mid/low VAD was linked to increased neonatal intracranial hemorrhage and seizures, but lower odds of meconium aspiration compared to ECD.
- Long-term follow-up showed mid/low VAD was not associated with increased risks for ADHD, ASD, CP, or epilepsy.
- Mid/low VAD was associated with a reduced risk of intellectual disability compared to ECD; outlet VAD outcomes were similar to SVD.
Conclusions:
- Mid/low VAD is associated with higher neonatal morbidity but not increased long-term neurodevelopmental disorder risks.
- Outlet VAD demonstrates no signal of adverse long-term neurodevelopmental outcomes.
- Findings suggest VAD is generally safe long-term when performed appropriately, addressing a significant knowledge gap.
