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Results for “OBSTETRICAL FORCEPS”

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At least 217 records · Page 12Linked to original sources

PubMed1996

Is permanent congenital facial palsy caused by birth trauma?

OBJECTIVE: To study the relation between traumatic birth and the development of permanent facial palsy in the newborn. DESIGN: Retrospective case control study of children with 'congenital' facial palsy. SETTING: Two tertiary referral centres for patients with facial palsy. SUBJECTS: 61 children with established facial palsy. MAIN OUTCOME MEASURES: Odds ratios of recognised factors for birth injury: maternal primiparity, high birth weight, and the use of obstetric forceps at delivery. RESULTS: 13.2% of those studied had forceps assisted delivery compared to 10.2% in the normal population (odds ratio 1.34; 95% confidence intervals 0.61 to 2.97) 39.6% were born to primiparae compared to a national rate of 36.7% (1.13; 0.65 to 1.96) and only 18.9% weighed more than 3500 g at birth (0.37; 0.19 to 0.74). CONCLUSIONS: There is no association between the development of permanent 'congenital' facial palsy and recognised risk factors for birth injury. These data suggest an intrauterine rather than a traumatic aetiology.

Birth Injuries↗

PubMed2002

Rupture of the larynx in a newborn.

BACKGROUND: Lesions of the laryngotrachea due to repeated intubation trauma after birth are reported. CASE: A macrosomic neonate was born at term after uneventful pregnancy. On the basis of diminished uterine contractions and arrest of descent, the head was delivered by using obstetric forceps. No intubation was attempted after birth. Ten hours later, the infant developed acute life-threatening respiratory distress and subcutaneous emphysema. Intubation was impossible. Open surgical exploration of the neck revealed a rupture of the cricothyroid ligament within the larynx. The defect was closed immediately, and after artificial ventilation for 7 days, the infant was extubated. One year later, the child is developing satisfactorily, without stridor or hoarseness. CONCLUSION: In macrosomic neonates after traumatic delivery, a laryngotracheal lesion should be considered when respiratory distress syndrome combined with subcutaneous emphysema occurs.

Birth Injuries↗

PubMed2002

Clinical study on labor pain relief using the combined spinal-epidural analgesia and inhaling nitrous oxide.

OBJECTIVE: To study the pain relief effectiveness of the combined spinal-epidural analgesia (CSEA) and the inhalation of nitrous oxide, and the influences on the mothers and infants. METHODS: The 300 cases of pregnant women were randomly divided into 3 groups: CSEA group, nitrous oxide group and control group. The nitrous oxide group was that pregnant women inhaled nitrous oxide premixed with oxygen (50%:50%), the pregnant women of the CSEA group were injected fentanyl and bupivacaine in the subarachnoid and epidural space, analgesic was not used in the control group. The degree of labor pain, duration of the labor, way of delivery, bleeding volume, rate of anoxia of newborn, blood gas analysis to maternal radius artery and fetal umbilical blood among 3 groups were observed. RESULTS: The effect for analgesia labor of the CSEA group was much better than that of the nitrous oxide group (P < 0.01). In the first stage of labor and total stage of labor, the CSEA group was shorter than the others (P < 0.05), but there was no difference between the nitrous oxide group and the control group (P > 0.05). In the second stage of labor, the 3 groups were alike to each other. The bleeding volume of caesarean section (373 +/- 77) ml in the nitrous oxide group was much more than the other 2 groups, there was no difference between the CSEA group (259 +/- 78) ml and the control group (239 +/- 89) ml. The rate of obstetric forceps of CSEA group was higher than the control group (P < 0.01), and the rate of caesarean section of the nitrous oxide group was much higher than the CSEA group. The blood gas analysis to maternal radius artery and fetal umbilical blood and the rate of anoxia of newborn of 3 groups revealed no significant difference. CONCLUSIONS: The effectiveness of the combined spinal-epidural analgesia CSEA for analgesia labor is confirmed and has rarely side-effect, and it can be the first choice, and the inhalation of nitrous oxide can safely provide effective labor analgesia, too.

Analgesia, Epidural↗

PubMed1984

A brief history of intrauterine pressure measurement.

In 1861 the development of obstetrical forceps to measure the degree of uterine expulsive forces gave impetus to investigations of uterine physiology. Although many methods were devised, the intrauterine balloon, used in the first successful attempt to evaluate activity of the gravid uterus in 1872, remained the standard by which other methods were judged. Alternate methods (such as the open catheter technique, hysterosalpingography, electrouterography, and external hysterography) were limited by cumbersome equipment, inaccurate gauges, difficulty in construction, excessive uterine irritation, and restriction of patient movement. A century of technological improvements in the intrauterine balloon and transducers made possible pioneering work in understanding the activity of the nongravid uterus, the concept of the rhythm method of birth control, carbon dioxide in the determination of tubal patency, and hormonal effects on reproduction and ovulation. Finally, understanding uterine contractile malfunction has given rise to the rational treatment of patients with dysmenorrhea.

Action Potentials↗

PubMed1994

Differences in obstetrical intervention rates between Dutch hospitals.

Within the framework of the project 'Obstetric Peer Review' (Verloskundige Onderlinge Kwaliteitsspiegeling, VOKS) differences between Dutch hospitals concerning various obstetrical interventions were investigated. Using data of the Perinatal Database of the Netherlands from hospitals with at least 2000 newborns in the 5-year period 1987-1991, remarkable differences in frequencies of labour induction, caesarean section and vaginal operative deliveries can be shown, even when these interventions were considered within homogeneous subgroups with respect to pregnancy- or delivery-related complications. The incidence of caesarean section (and labour induction and vaginal operative delivery) appeared to depend more on the specific hospital policy than might be explained by populations differences alone. These intervention differences between hospitals clearly demonstrated the need to carry out a multivariate analysis to compare hospitals in a relevant and unbiased way, while adjusting for these population differences. This will estimate the intervention risks in a way which allows a fair comparison of hospital intervention policies.

Cesarean Section↗

PubMed1999

Effects of obstetrician characteristics on cesarean delivery rates. A community hospital experience.

OBJECTIVE: Despite a decrease in the overall cesarean delivery rate at Ravenswood Hospital Medical Center in Chicago, a wide range of variation existed among individual obstetricians' rates. This study evaluated obstetricians' characteristics to determine whether they affected cesarean delivery rates. STUDY DESIGN: In 1994 members of my department adopted strategies to decrease the cesarean delivery rate. Data on women who were delivered at the obstetric unit from 1994-1997 and data on their neonates were studied. Certain characteristics of obstetricians were also analyzed. The data were grouped according to personal characteristics and obstetricians' cesarean delivery rates: group 1 had a low rate (</=15%) and group 2 had a high rate (>15%). Pearson chi2 analysis was used to evaluate the differences between the proportions. P <.05 was considered significant. RESULTS: The departmental cesarean delivery rate decreased from 20.5% in 1994 to 15.5% in 1997 (P <.0001), whereas individual obstetricians' rates varied from 0% to 44.4%. Obstetricians in group 1 (average rate 12.2%) and group 2 (average rate 20.8%, P <.0001) served similar populations with similar outcomes. Compared with obstetricians in group 2, those in group 1 (low rate) performed more vaginal deliveries after cesarean birth and used epidural analgesia and the vacuum extractor more frequently. Young age of physician, graduation from a domestic medical school, group practice, and smaller volume of births were all significantly linked to lower cesarean delivery rates. CONCLUSIONS: Cesarean delivery rates can safely be reduced. Certain individual obstetrician characteristics influence cesarean delivery rates. Obstetricians' commitment facilitates lowering of cesarean delivery rates.

Adult↗

PubMed2004

Can formal education and training improve the outcome of instrumental delivery?

OBJECTIVE(S): The primary objective was to examine the effect of formal education and training on instrumental delivery with respect to its success rate and associated neonatal and maternal morbidity. The secondary objective was to determine factors that could influence the success rate of instrumental delivery. STUDY DESIGN: Prospective case-control study with historical controls set in a teaching hospital in Sheffield. The prospective group included all women who had instrumental deliveries between 1 November 1999 and 29 February 2000. The control group included all women who delivered between 1 February 1997 and 1 February 1998. An educational package involving formal postgraduate training and self-directed learning were introduced in the time period between the prospective and the control groups. Medical notes were reviewed in the historical controls. For both the control and prospective groups, the following patient characteristics were recorded: maternal age, parity, whether or not onset of labour was induced, use of oxytocin in the second stage of labour, delay in the second stage, operator grade, vaginal findings at delivery and the use of epidural analgesia. RESULTS: The overall failure rate was not different in the prospective group (16%) compared with the control group (18.5%). However, the introduction of an educational package was associated with significant decrease in maternal morbidity associated with cervical, severe labial and high vaginal tears (Odds Ratio (OR) 0.29, CI 0.09-0.97) and neonatal morbidity associated with admission to SCBU (OR 0.72, CI 0.02-0.60), severe neonatal scalp injury (OR 0.14, CI 0.02-0.98) and facial injuries (OR 0.02, CI 0.01-0.04). The factors identified to affect the success of instrumental deliveries were: OP and OT positions of the baby at delivery (OR 0.28, CI 0.17-0.44) and inexperienced operators (OR 0.11, CI 0.02-0.58). CONCLUSION: In this study, formal education and training of medical staff did not influence the success rate of instrumental delivery but was associated with improved safety for both mother and baby.

Anal Canal↗

PubMed2003