Mode of Delivery among HIV-Infected Pregnant Women in Philadelphia, 2005-2013

Objective

Current guidelines call for HIV-infected women to deliver via scheduled Caesarean when the maternal HIV viral load (VL) is >1,000 copies/ml. We describe the mode of delivery among HIV-infected women and evaluate adherence to relevant recommendations.

Study Design

We performed a population-based surveillance analysis of HIV-infected pregnant women in Philadelphia from 2005 to 2013, comparing mode of delivery (vaginal, scheduled Caesarean, or emergent Caesarean) by VL during pregnancy, closest to the time of delivery (≤1,000 copies/ml versus an unknown VL or VL >1,000 copies/ml) and associated factors in multivariable analysis.

Results

Our cohort included 824 deliveries from 648 HIV-infected women, of whom 69.4% had a VL ≤1,000 copies/ml and 30.6% lacked a VL or had a VL >1,000 copies/ml during pregnancy, closest to the time of delivery. Mode of delivery varied by VL: 56.6% of births were vaginal, 30.1% scheduled Caesarean, and 13.3% emergent Caesarean when the VL was ≤1,000 copies/ml; when the VL was unknown or >1,000 copies/ml, 32.9% of births were vaginal, 49.9% scheduled Caesarean and 17.5% emergent Caesarean. In multivariable analyses, Hispanic women (adjusted odds ratio (AOR) 0.17, 95% Confidence Interval (CI) 0.04–0.76) and non-Hispanic black women (AOR 0.27, 95% CI 0.10–0.77) were less to likely to deliver via scheduled Caesarean compared to non-Hispanic white women. Women who delivered prior to 38 weeks’ gestation (AOR 0.37, 95% CI 0.18–0.76) were also less likely to deliver via scheduled Caesarean compared to women who delivered after 38 weeks’ gestation. An interaction term for race and gestational age at delivery was significant in multivariable analysis. Non-Hispanic black (AOR 0.06, 95% CI 0.01–0.36) and Hispanic women (AOR 0.03, 95% CI 0.00–0.59) were more likely to deliver prematurely and less likely to deliver via scheduled C-section compared to non-Hispanic white women. Having a previous Caesarean (AOR 27.77, 95% CI 8.94–86.18) increased the odds of scheduled Caesarean delivery.

Conclusions

Only half of deliveries for women with an unknown VL or VL >1,000 copies/ml occurred via scheduled Caesarean. Delivery prior to 38 weeks, particularly among minority women, resulted in a missed opportunity to receive a scheduled Caesarean. However, even when delivering at or after 38 weeks’ gestation, a significant proportion of women did not get a scheduled Caesarean when indicated, suggesting a need for focused public health interventions to increase the proportion of women achieving viral suppression during pregnancy and delivering via scheduled Caesarean when indicated.     

Gestation length, mode of delivery, and neonatal line-thickness variation

The transition from an intra- to extra-uterine environment leaves its mark in deciduous teeth (and first permanent molars) as an accentuated enamel incremental ring called the neonatal line (NL). This prominent microfeature separates the enamel formed during intrauterine life from that formed after leaving the womb. However, while the physical structure of this scar is well known, the bases of its formation are still a matter of investigation. In particular, besides the influence of the birth-related abrupt environmental and dietary changes and the role played by physiological factors such as hypocalcaemia, a direct relationship between NL thickness variation and the physical was trauma implied by the birth dynamics, the Caesarean, and the operative modes are apparently associated with the thinnest and the thickest lines, respectively. By using the histological record from a deciduous dental sample (exfoliated crowns) of 100 modern healthy school-aged children (47 males and 53 females) of reported birth histories (normal delivery mode: 55 cases; Caesarean: 40; operative: 5), we investigated the relationships between birth dynamics and NL thickness variation. The Tukey Honest Significant Difference method was used to test the differences between the means of the grouping levels. The results of our histo-morphological investigation do not support the suggestion that Caesarean-born children display, on average, a thinner enamel scar compared to children associated to a normal delivery mode. Rather, our study points to the influence exerted by factors intimately related to gestational length variation on the degree of expression of the line.     

黄土高原草地净初级生产力时空趋势及其驱动因素

草地净初级生产力是生态系统碳循环的关键环节和重要组成部分.本研究使用分段线性回归分析和Pearson相关分析,分析了黄土高原2000-2015年间土地利用类型未改变的草地净初级生产力(NPP)的变化趋势及气候核心因子(年降水量、年强降水量、年有效降水日数、年平均温度、年最高温度、年最低温度)对NPP变化的影响,并借助增...     

Down syndrome in British Columbia, 1952-73: incidence and mean maternal age.

Records of children with Down syndrome (DS) at the BC Health Surveillance Registry were linked to their Birth Registrations to derive maternal ages. Incidence and maternal-age specific rates were calculated for 1952-73. Mean maternal age has declined both for normal and DS children, the latter to a marked degree, so that in 1972-73 80% were born to women under 35 years. Using maternal age of 40 and over as an indication for amniocentesis would only detect 10% of DS children. The crude incidence rate (mean 1.28/1000 livebirths) has not changed appreciably over the study period except for 1969 in which a statistically significant peak occurred. The standarized rate showed an increasing trend but it is not clear whether this was a true biological increase or resulted from better ascertainment.     

Facial nerve palsy in the newborn: incidence and outcome

This study retrospectively identifies and characterizes patients with facial palsy related to birth trauma and describes the natural history of this disorder. The records of infants born with facial weakness or paralysis over a 5-year period at Brigham and Women's Hospital were reviewed, and criteria were defined to assign a diagnosis of acquired facial palsy based on birth history and documented physical examinations. The majority of patients were followed up by interview with a family member. Among 44,292 infants born between October 1, 1982 and July 31, 1987, there were 92 recorded cases of congenital seventh nerve palsy. Of these, 81 were acquired, for an incidence of 1.8 per 1000. Seventy-four of the 81 (91 percent) were associated with forceps delivery. By contrast, obstetric forceps were used in 19 percent of all deliveries during the period of the study. The average weight of subjects was 3.55 kg, versus a mean overall birth weight of 3.23 kg. Fifty-nine percent of mothers of affected children and 37 percent of controls were prima gravidas. Forceps delivery, birth weight of 3500 gm or more, and primiparity were all significant risk factors for acquired facial palsy. The incidence of additional birth injuries also was substantially higher among affected subjects than among the general population of newborns. Sixty-six of 81 patients had adequate follow-up. Recovery has been complete for 59 patients (89 percent) and incomplete for the remaining 7 (mean follow-up 34 months). In summary, congenital traumatic facial palsy has definable risk factors and a predictably favorable outcome.     

晋南地区冬小麦生育期气候变化特征及其对产量的影响

明确气候变化特征及其对小麦生产的影响,有助于为农业适应气候变化方案的制定提供理论依据.本研究分析了晋南小麦主产区临汾、运城市1957-2015年降水量、气温、日照时长、潜在蒸散量、干燥度等变化及其对冬小麦生育期及产量的影响.结果 表明:1957-2015年,临汾、运城市全年降水量和冬小麦生育期日照时长均呈下降趋势,冬小...     

Obstructed labor and caesarean delivery: the cost and benefit of surgical intervention

Background

Although advances in the reduction of maternal mortality have been made, up to 273,000 women will die this year from obstetric etiologies. Obstructed labor (OL), most commonly treated with Caesarean delivery, has been identified as a major contributor to global maternal morbidity and mortality. We used economic and epidemiological modeling to estimate the cost per disability-adjusted life-year (DALY) averted and benefit-cost ratio of treating OL with Caesarean delivery for 49 countries identified as providing an insufficient number of Caesarean deliveries to meet demand.

Methods and Findings

Using publicly available data and explicit economic assumptions, we estimated that the cost per DALY (3,0,0) averted for providing Caesarean delivery for OL ranged widely, from $251 per DALY averted in Madagascar to $3,462 in Oman. The median cost per DALY averted was $304. Benefit-cost ratios also varied, from 0.6 in Zimbabwe to 69.9 in Gabon. The median benefit-cost ratio calculated was 6.0. The main limitation of this study is an assumption that lack of surgical capacity is the main factor responsible for DALYs from OL.

Conclusions

Using the World Health Organization''s cost-effectiveness standards, investing in Caesarean delivery can be considered “highly cost-effective” for 48 of the 49 countries included in this study. Furthermore, in 46 of the 49 included countries, the benefit-cost ratio was greater than 1.0, implying that investment in Caesarean delivery is a viable economic proposition. While Caesarean delivery alone is not sufficient for combating OL, it is necessary, cost-effective by WHO standards, and ultimately economically favorable in the vast majority of countries included in this study.     

Development of the Corticospinal and Callosal Tracts from Extremely Premature Birth up to 2 Years of Age

White matter tracts mature asymmetrically during development, and this development can be studied using diffusion magnetic resonance imaging. The aims of this study were i. to generate dynamic population-averaged white matter registration templates covering in detail the period from 25 weeks gestational age to term, and extending to 2 years of age based on DTI and fractional anisotropy, ii. to produce tract-specific probability maps of the corticospinal tracts, forceps major and forceps minor using probabilistic tractography, and iii. to assess the development of these tracts throughout this critical period of neurodevelopment. We found evidence for asymmetric development across the fiber bundles studied, with the corticospinal tracts showing earlier maturation (as measured by fractional anisotropy) but slower volumetric growth compared to the callosal fibers. We also found evidence for an anterior to posterior gradient in white matter microstructure development (as measured by mean diffusivity) in the callosal fibers, with the posterior forceps major developing at a faster rate than the anterior forceps minor in this age range. Finally, we report a protocol for delineating callosal and corticospinal fibers in extremely premature cohorts, and make available population-averaged registration templates and a probabilistic tract atlas which we hope will be useful for future neonatal and infant white-matter imaging studies.     

气候变化对宁夏固原地区胡麻发育进程和产量的影响

基于观测数据分析了宁夏固原地区平均温度和降水的年际变化,探讨了气候变化对当地胡麻发育进程和产量的影响状况.结果表明： 1957—2012年,固原地区年均气温呈上升趋势,年降水量呈下降趋势,气候倾向率分别为0.3 ℃·(10 a)^-1、-20 mm·(10 a)^-1;胡麻生长季平均温度的上升趋势更明显,降水的下降趋势则与年趋势类似.气温升高和降水减少加快了胡麻的发育速度,导致其生育期天数呈显著减少趋势.胡麻播种至出苗期温度每上升1 ℃,出苗期提前0.7 d;出苗至二对针叶期,温度每上升1 ℃,发育天数缩短0.8 d,降水量每减少1 mm,发育天数缩短0.1 d;工艺成熟至成熟期温度每上升1 ℃,成熟期提前1.8 d,降水量每减少1 mm,成熟期提前0.1 d.胡麻营养生长阶段平均温度升高、降水减少使发育加速是胡麻产量逐年降低的主要原因之一;生殖生长阶段温度升高会抑制花芽分化及正常授粉,对蒴果数和结实率产生影响而导致产量降低.调整胡麻品种种植布局、扩大中晚熟或晚熟品种比例是当地减少气候变化影响的重要措施.     

Estimation of the effects of climate change and human activities on runoff in different time scales in the Beichuan River Basin,China

Abstract

Assessing the impacts of climate change and human activities on runoff is important for planning and managing water resources and for maintaining the integrity of the ecosystem, as well as the normal operation of modern society. In this study, the distribution of precipitation in the Beichuan River basin from 1961 to 2013 is uneven, and we analyzed the impacts of climate change and human activity on the annual and seasonal runoff change during this period. The results showed that runoff was more sensitive to precipitation than the other meteorological factors during the study period, and a 10% increase in precipitation could increase runoff by 17.5%. The annual runoff showed a downward trend during the past 53 years, with an abrupt change point in 1972. We concluded that human activities were mainly responsible for the runoff reduction, and climate change accounted for approximately 30% of the reduction. For the change in seasonal runoff, the dry season runoff had no significant trend, but there was a downward trend in the wet season runoff, with an abrupt change point in 1998. We concluded that human activities were the dominant cause of the reduction in the wet season runoff (88.27%), and climate change accounted for 11.73% of the reduction.     

呼伦贝尔草原MODIS NDVI的时空变化特征

基于2000—2008年的MODIS NDVI数据,研究了呼伦贝尔草原4种主要草原类型（低地草甸、温性草原、温性草甸草原和山地草甸）年NDVI_max的空间变化趋势、波动程度、出现时间.结果表明：2000—2008年,呼伦贝尔草原植被趋于恶化的形势较严峻;研究区类草原NDVI_max平均值的年际波动明显,特别是温性草原NDVI_max平均值的年际最大波动接近50%;在各等级草原面积的变化上,尽管NDVI_max在(0.4,1］之间的草原平均面积约占研究区总面积的91%,说明呼伦贝尔草原植被状况总体较好,但NDVI_max值在(0.2,0.4]、(0.8,1］之间的草原面积趋于减少,NDVI_max在(0.4,0.8］之间的中高盖度草原面积趋于增加,总体形势不容乐观;66.25%的研究区草原植被状况趋于恶化,33.75%趋于好转;62.85%研究区的NDVI_max出现在每年第193天至第225天（即7月中旬至8月初）,该时期是呼伦贝尔草原植被最重要的生长季节.     

Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study

Objective To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery.Design Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health.Setting 410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided dataParticipants 106 546 deliveries reported during the three month study period, with data available for 97 095 (91% coverage).Main outcome measures Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics.Results Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective.Conclusions Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.     

Should we abandon Kielland's forceps?

To assess the risks associated with the use of Kielland''s forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.5%) were delivered with Kielland''s forceps. There was no difference in early neonatal outcome (as judged by Apgar scores, intubations, and admission to the special care baby unit) between these babies and those delivered normally or by non-rotational forceps, but a higher proportion of the 127 (10.7%) delivered by emergency caesarean section were compromised. Of the 1517 multigravid patients, only 57 (3.8%) underwent instrumental delivery, 15 (1.0%) by Kielland''s forceps. Among these babies, also, the outcome was no worse than for those delivered normally, but the babies delivered by caesarean section showed a greatly increased incidence of low Apgar scores, intubations, and admission to the special care baby unit. There were no stillbirths or neonatal deaths among babies delivered by Kielland''s forceps, nor were there any cases of severe birth trauma or of obvious neonatal morbidity.     

雅鲁藏布江流域NDVI变化与风沙化土地演变的耦合关系

运用1982-2010年的两种NDVI数据集（Pathfinder AVHRR和SPOT VEGETATION）,以及1975、1990、2000和2008年4期遥感数据,通过GIS技术、人工目视解译和灰色关联分析方法,研究了雅鲁藏布江流域NDVI变化和风沙化土地演变的耦合关系,结合1957-2007年降水和气温逐日气象资料,探讨了气候变化对其耦合关系的影响。结果表明：（1）流域内1982-2010年NDVI的年际变化总体上呈波动式增长的趋势。NDVI空间分布呈现由下游向中上游逐渐降低的趋势,以米林宽谷最大、马泉河宽谷最小。（2）2008年流域内共有风沙化土地273 697.54hm²,呈现由江源区马泉河宽谷向中下游递减的趋势。1975-2008年流域内风沙化土地呈缓慢增长趋势,以1990-1999年增长率最高,2000-2008年的增长率最小。（3）对于NDVI年变化和植被生长季（7-9月份）的变化,马泉河宽谷受平均气温的影响最大,日喀则宽谷和山南宽谷受年降水量的影响最大;米林宽谷NDVI的年变化受风沙化土地扩展的影响最大,植被生长季变化受年降水量的影响最大。（4）不同宽谷段NDVI与风沙化土地年变化的关联度自下游向中上游呈总体减小的趋势。流域尺度NDVI植被生长季变化主要受平均气温和年降水量的影响,非植被生长季（10月-翌年6月）变化主要受风沙化土地扩展的影响。     

Differential Effects of Epidural Analgesia on Modes of Delivery and Perinatal Outcomes between Nulliparous and Multiparous Women: A Retrospective Cohort Study

Background

Epidural analgesia is considered one of the most effective methods for pain relief during labor. However, it is not clear whether similar effects of epidural analgesia on the progression of labor, modes of delivery, and perinatal outcomes exist between nulliparous and multiparous women.

Methodology/Principal Findings

A retrospective cohort study was conducted to analyze all deliveries after 37 weeks of gestation, with the exclusion of pregnancies complicated by multiple gestations and fetal anomalies and deliveries without trials of labor; these criteria produced a study population of n=16,852. A multivariable logistic regression model was constructed to control for confounders. In total, 7260 of 10,175 (71.4%) nulliparous and 2987 of 6677 (44.7%) multiparous parturients were administered epidural analgesia. The independent factors for intrapartum epidural analgesia included a low prepregnancy body mass index, genetic amniocentesis, group B streptococcal colonization of the genito-rectal tract, and augmentation and induction of labor. In the nulliparous women, epidural analgesia was a significant risk factor for operative vaginal delivery (adjusted odds ratio [OR] 2.14, 95% confidence interval [CI] 1.80-2.54); however, it was a protective factor against Caesarean delivery (adjusted OR 0.62, 95% CI 0.55-0.69). Epidural analgesia remained a significant risk factor for operative vaginal delivery (adjusted OR 2.17, 95% CI 1.58-2.97) but not for Caesarean delivery (adjusted OR 1.09, 95% CI 0.77-1.55) in the multiparous women. Furthermore, the women who were administered epidural analgesia during the trials of labor had similar rates of adverse perinatal outcomes compared with the women who were not administered epidural analgesia, except that a higher rate of 1-minute Apgar scores less than 7 was noted in the nulliparous women who were administered epidural analgesia.

Conclusions/Significance

Intrapartum epidural analgesia has differential effects on the modes of delivery between nulliparous and multiparous women, and it is not associated with adverse perinatal outcomes.     

长江中下游地区农业气候资源时空变化特征

以1981年为时间节点,将1961-2007年分为1961-1980年（时段Ⅰ）和1981-2007年（时段Ⅱ）两个时间段,分析和比较两个时段的农业气候资源变化特征.结果表明：气候变暖背景下,长江中下游地区1961-2007年温度生长期内≥10 ℃积温气候倾向率平均为74 ℃·d·10 a^-1;时段Ⅱ≥10 ℃积温较时段Ⅰ平均增加了124 ℃·d;与时段Ⅰ相比,时段Ⅱ双季稻的安全种植界限向北推移了0.79个纬度.1961-2007年温度生长期内降水量总体表现为增加趋势;与时段Ⅰ相比,时段Ⅱ降水量增加了1.6%,降水量≥767 mm（双季稻正常生长的需水量）的面积增加了1.13×10.4 km².时段Ⅱ温度生长期内日照时数较时段Ⅰ平均减少了8.1%;近47年中91.1%的气象站点日照时数表现为减少趋势.与时段Ⅰ相比,时段Ⅱ温度生长期内参考作物蒸散量呈略微减少趋势,其低值区扩大、高值区缩小.时段Ⅱ稳定通过10 ℃初日平均较时段Ⅰ提前了2 d,而时段Ⅱ≥20 ℃终日平均较时段Ⅰ推迟了2 d,两个时段 ≥22 ℃终日基本相同.     

Pregnancy in diabetic women: outcome with a program aimed at normoglycemia before meals.

A program designed to achieve normal plasma glucose concentrations before meals was tested in 83 insulin-dependent diabetic women during 110 pregnancies. The women rigidly controlled their carbohydrate intake but not their total energy intake, and twice daily they injected a combination of short-acting (Toronto) and intermediate-acting (NPH or Lente) insulin. Obstetric care was highly individualized and was aimed at avoiding or minimizing the impact of complications, such as hypertension, on the fetus and ensuring fetal lung maturity before delivery. The mean plasma glucose levels before meals (+/- standard error of the mean) were 136 +/- 9, 117 +/- 5 and 101 +/- 2 mg/dl during the first, second and third trimesters respectively. Obstetric complications included hypertensive disease of pregnancy (in 30.0%) and hydramnios (in 16.4%). The mean gestational age (+/- standard deviation [SD]) was 38.1 +/- 1.8 weeks, the cesarean section rate 45.4% and the mean stay in hospital for diabetes control before delivery (+/- SD) 15.7 +/- 9.6 days. The perinatal mortality rate was 0.9%. Neonatal problems included congenital anomalies in 3.6%, somatomegaly in 24.6%, hypoglycemia in 26.5%, hypocalcemia in 17.3% and hyperbilirubinemia in 39.4%. There were nine cases (8.2%) of the respiratory distress syndrome, four (3.6%) of which were severe. These findings lend support to the importance of a policy aimed at achieving normoglycemia and fetal lung maturity before delivery, goals that are attainable without lengthy antenatal hospitalization.     

Microbial ecology of Campylobacter jejuni in a United Kingdom chicken supply chain: intermittent common source, vertical transmission, and amplification by flock propagation.

A study of Campylobacter jejuni on a broiler chicken farm between 1989 and 1994 gave an estimated isolation rate of 27% (3,304 of 12,233) from a 0.9% sample of 1.44 million broiler chickens from six to eight sheds over 32 consecutive rearing flocks comprising 251 broiler shed flocks. During the study, C. jejuni was found in 35.5% of the 251 shed flocks but only 9.2% (23 of 251) had Campylobacter isolates in successive flocks, with 9 of those 23 sheds having the same serotype between consecutive flocks, indicating a low level of transmission between flocks. Analysis of a systematic sample of 484 of 3,304 (14.6%) C. jejuni isolates showed that 85% were of 10 serotype complexes but 58% were of 3 serotype complexes, indicating a high degree of strain similarity throughout the entire study. The three commonest types were detected in 8 of 32 flocks during the 5-year study period, suggesting an intermittent common external Campylobacter source. This hypothesis was tested by a retrospective cohort analysis of C. jejuni rates and types by reference to hatchery supplier of the 1-day-old chicks. Isolation rates of C. jejuni and frequency distribution of types were determined in 6-week-old broiler chickens identified by the hatchery supplying the original chicks. The isolation rate of C. jejuni in broilers, supplied by hatchery A, was 17.6%, compared to 42.9% (P < 0.0001) for broilers reared from chicks supplied by hatchery B. In two instances, when both hatcheries were used to stock the same farm flock, Campylobacter isolates were found only in those sheds with chicks supplied by hatchery B. Thus, the frequency distribution of Campylobacter types for chickens supplied by the two hatcheries over the 5-year period showed marked dissimilarity. These findings suggest that the isolation rate and type of Campylobacter isolates in broiler chickens was associated with the hatchery supplying chicks. The lack of diversity of types and the intermittent high positivity of sheds is evidence for a common source of C. jejuni introduced by vertical transmission rather than contamination at the hatchery or during transportation.     

Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis

Objective To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries.Design Population based study.Setting US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file.Participants Singleton live births in the United States (n = 11 639 388) and New Jersey (n = 375 351).Main outcome measures Neonatal morbidity and mortality.Results Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95% confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and need for assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; ≥ 30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery. The sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears.Conclusion Although vacuum extraction does have risks, it remains a safe alternative to forceps delivery.