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PubMed2000

[Surgical methods for delivery in modern obstetrics and their influence on maternal and infant health].

The article addresses issues of comparative characterization of deliveries involving surgery and impact thereof on the health of the mother and her child. Risk factors are identified that the mother and her child run in sectio cesarea, in application of obstetrical forceps, and in vacuum-extraction of the fetus. Cesarean section was found out to be the most acceptable mode of delivery in origination of organic and functional nervous system involvement in children but the most ill-chosen and unpropitious one in the mother, especially so in those groups at risk for bleeding, septic complications, and genital endometriosis. Among those surgical methods of delivery being the least traumatic to the mother are obstetrical forceps and vacuum-extraction of the fetus.

Adult↗
PubMed2004

[Changes in Norwegian obstetric practices, 1915-1961].

BACKGROUND: Established in 1967, the Medical Birth Registry of Norway has detailed accounts of all births in Norway. We have, however, only limited knowledge of obstetric practices in Norway in the decades before the Birth Registry was established. One important source is the annual reports of the Maternity Clinic in Oslo. MATERIAL: We analysed the annual reports for the period 1915-1961 with special emphasis on operative deliveries. RESULTS: The obstetric forceps was used in 6.5-12.5% (median 8.7%) of cephalic presentations. In 1960, the vacuum extractor was used for the first time. The rate of caesarean sections increased from 1.5% in the late 1930s to 6.3% in 1961. The proportion of operative deliveries increased up until 1944-55 when it was 14-16%, then fell in the years to 1960 when it was about 12%. Between 1915-1934, maternal mortality was as high as 6.4 per thousand. From the mid-1930s, it steadily decreased to 0.6 per thousand in the last five-year period. Well over one third of the deaths were caused by eclampsia or serious preeclampsia. INTERPRETATION: Birth traumas and neonatal death was the price paid for saving the mothers' lives and health. The operative activity was higher than what might be expected on the basis of the late-1960s data in the Birth Registry. The increase in caesarean sections was steepest during the Second World War, at a time when the number of deliveries in the clinic rose substantially.

Birth Rate↗
PubMed1990

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.

Birth Injuries↗
PubMed1999

Kielland vs. nonrotational forceps for the second stage of labor.

OBJECTIVE: To examine and compare maternal and neonatal morbidity after use of two types of obstetric forceps used in the management of the second stage of labor. STUDY DESIGN: This retrospective investigation was conducted from January 1993 to December 1995 and included 55 infants delivered with Kielland forceps as compared to 213 infants delivered with nonrotational forceps. The maternal and neonatal charts were reviewed for data collection. Maternal complications compared included blood loss, vaginal lacerations, postpartum hemorrhage, and third- and fourth-degree perineal lacerations. Infant data collected compared fetal lacerations, nerve palsies, shoulder dystocias, blood gas values and admissions to the neonatal intensive care unit. Statistical analysis was performed by Fisher's exact, chi 2 and Student's t test. RESULTS: Women in both groups were similar with respect to age, gravidity, parity and estimated gestational age at delivery. Infants were similar in both groups with respect to fetal weight, admissions to the neonatal intensive care unit, nerve compromise, scalp lacerations and facial bruising. The Kielland group had statistically significantly longer labor, 671 +/- 285.8 vs. 614 +/- 226.5 minutes (P < .05) and longer second stage of labor 184 +/- 74.71 vs. 161 +/- 65.79 minutes (P < .05). The Kielland group also had a statistically higher percentage of one-minute Apgar scores < 6, 18.2% vs. 4.7% (P < .05), and meconium present at delivery, 14.5% vs. 5.6% (P < .05). CONCLUSION: Management of the second stage of labor can be accomplished safely with Kielland forceps and rotation of the fetal head. Supervision by an experienced operator will allow residents to be trained with respect to appropriate patient selection and application of these forceps.

Apgar Score↗
PubMed1992

Vaginal foreign body extraction by forceps: a case report.

Cases in which foreign bodies have been inserted into the vagina are uncommon but do occur. The technique and use of obstetric forceps for the extraction of an orange as a vaginal foreign body is described in this case report. Tucker-McLane forceps are the forceps of choice for this technique in this case.

Adult↗
PubMed1996

Forceps and vacuum injuries to the cornea: histopathologic features of twelve cases and review of the literature.

Histopathologic and ultrastructural features were examined from 11 cases of corneal injury from obstetrical forceps and one case from vacuum extraction. Four major types of histopathologic features were observed. Type I (n = 4) included large tears of Descemet's membrane with a fragment of Descemet's membrane extending into the anterior chamber at one end of the tear and scroll formation at the other end. Type II (n = 6) consisted of scrolls of Descemet's membrane at each margin of the original break. Type III (n = 2) included those with small breaks in Descemet's membrane and healing by fibrosis at and posterior to the original tear. Type IV (n = 1) contained a small break in Descemet's membrane with minimal fibrosis. Transmission electron microscopy revealed Descemet's scrolls and retrocorneal fibrous tissue. Scanning electron microscopy revealed folds in Descemet's membrane and attenuation or absence of endothelium. Spindle- and stellate-shaped cells and pigment granules were present in the area of the tear in most cases. A review of the literature is presented.

Adult↗
PubMed1994

Outcome of forceps delivery versus vacuum extraction--a review of 200 cases.

The outcome of 100 patients undergoing instrumental delivery with vacuum extractor is compared with that of 100 women delivered with the aid of obstetric forceps. Forceps deliveries were more commonly associated with maternal birth canal trauma (including episiotomy) whilst vacuum extractor carried higher odds of the neonate developing jaundice. Apart from these, there were no significant differences between these two groups in terms of maternal morbidity, neonatal trauma and morbidity and ultimate outcome (success with the type of instrument used). We conclude that with meticulous handling of the instrument and with an appropriate decision on the indication and the type of instrument used, the maternal and neonatal outcome could be equally good with the use of either instrument.

Adult↗
PubMed2001

[Retinal lesion due to an obstetrical traumatism: a case report].

The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.

Atrophy↗
PubMedDate not supplied

Ankylosis of the temporomandibular joint as a complication of forceps delivery: report of a case.

A two and half years old girl presented with severe limitation of mouth opening, facial asymmetry, inability to masticate, and proclination of the anterior maxillary and mandibular teeth. There was no history of facial trauma, infection or neonatal fevers. A diagnosis of bony ankylosis of the TMJ was made following a confirmation of delivery by means of obstetrics forceps during a difficult labour. The causes of TMJ ankylosis and the sequaele are highlighted.

Ankylosis↗
PubMed1997

Case report: unilateral combined facial nerve and brachial plexus palsies in a neonate following a midlevel forceps delivery.

A case is described in which the 2.7-kg fetus of a nonobese primigravid patient, delivered by midlevel forceps manipulation sustained neurapraxias of both the marginal mandibular branch of the seventh cranial nerve and the upper trunks of the ipsilateral brachial plexus. The pregnancy was uneventful, but labor was complicated by an occipitoposterior presentation and a prolonged second stage. Examination of the neonate revealed bruising and skin markings consistent with injury by obstetric forceps and the anatomic location of these marks suggested that cervical and mandibular compression from the forceps, rather than traction by the accoucheur, would account for the observed findings. A review of the English language literature over the past 30 years revealed only four cases in which a combination of facial nerve and brachial plexus injuries could both be linked to obstetric instrumentation.

Adult↗
PubMed1986

Comparison of maternal and neonatal morbidity in midforceps delivery and midpelvis vacuum extraction.

The present study examines the incidence of maternal and neonatal morbidity associated with delivery from the midpelvis using the vacuum extractor when compared with obstetric forceps. Previous studies have failed to minimize the influence of confounding variables such as maternal and neonatal disease and indication for delivery on outcome when comparing determinants of maternal and neonatal morbidity in the two groups. Results indicate that there was significantly more maternal morbidity in forceps deliveries across most variables. There were no statistically significant differences in neonatal morbidity between the two groups except for a higher incidence of inconsequential cephalhematoma in the vacuum group. It is concluded that the vacuum extractor may be a valuable instrument in delivery from the midpelvis and that it should be more widely used in appropriate clinical situations.

Apgar Score↗
PubMed2006

Cerebellar-pulmonary embolism, cause of death in the newborn.

A 28-year-old woman delivered twin girls. The first twin was delivered without any difficulty. The head of the second twin failed to descend with pushing. A special kind of obstetrical forceps, Thierry's spatulas, were used to extract the second twin in the occipito-posterior vertex position. She was declared dead after recording Apgar scores of 0 and 0 and after 35 min of resuscitation. An autopsy was performed for medico-legal reasons. Macroscopic examination of the brain showed a small area of leptomeningeal haemorrhage in the left sylvian fossa and the base of the brain. Histopathological studies demonstrated cerebellar tissue emboli in meningeal and pulmonary arteries. Excessive pressure on the suboccipital region during delivery can cause traumatic separation of the occipital chondral junctions, which may lead to separation of the occipital squama from lateral parts of the occipital bones. The inferior part of the occipital squama is displaced forward and upward into the posterior fossa. This produces tearing of the duramater and occipital sinuses leading to leptomeningeal haemorrhage in the posterior cranial fossa, often associated with cerebellar lesions. Major stretching and tearing of the posterior aspect of tentorium cerebelli in contact with the sinuses and the cerebellar cortex may also occur, inducing slight movement of the occipital bones and subsequent emboli. This case study is that of a newborn death due to pulmonary cerebellar tissue embolism occurring during delivery with Thierry's forceps, which are considered less traumatic to the foetal cranium. A review of the literature identified 17 other published cases. In difficult deliveries this pathology should sought carefully. Brain, lung and placenta tissue sections must be studied.

Adult↗
PubMed2003

Forceps delivery at the University College Hospital, Ibadan, Nigeria.

UNLABELLED: The incidence of forceps delivery has reduced in Nigeria and in the world in general. Some Obstetricians have not been trained in its use and lack the skill. OBJECTIVE: To determine the outcome of forceps delivery at this centre. METHODOLOGY: A retrospective analysis of all forceps delivery done at this centre between the 1st of January 1997 and 31st December 2001, a 5-year period was done. RESULTS: The incidence of forceps delivery was 1.57% or 16 per 1000 births and they were all low cavity deliveries. Most of the patients (68.5%) were booked at this centre. The mean age was 28.21 +/- 4.79 years and most (64.4%) were nulliparious. The mean gestational age at delivery was 38.7 +/- 3.0 weeks. The most common indications were prolonged second stage of labour (58.9%), maternal distress (43.8%) and fetal distress (15.1%). There were multiple indications in some patients. The mean birth weight was 3.03 +/- 0.69 kgs and 90.4% were live births. The main maternal complications were maternal injuries (8.1%), primary post partum haemorrhage (5.5%), anaemia (5.5%) and retained products of conception (4.1%). Maternal deaths occurred in 2 eclamptics and birth asphyxia in 6.9% of babies. The perinatal mortality rate was 54.8 per 1000 births. There were no fetal injuries. CONCLUSION: Obstetrics forceps delivery is on the decline in Nigeria. It is an art that can safely and quickly deliver the fetus. It could be offered in the place of a caesarean section in some instances with a good outcome to both the mother and fetus in skilled hands. Obstetricians should be trained to use it more frequently.

Adult↗