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PubMed2002

U.S. trends in obstetric procedures, 1990-2000.

BACKGROUND: During the 1980s the rate of obstetric procedures performed during delivery rose precipitously. This study follows the use of obstetric procedures through the 1990s to explore whether the patterns witnessed in the previous decade continued through the next. METHODS: Data on total obstetric procedures and eight specific procedures (cesarean section, medical and surgical induction of labor, other artificial rupture of membranes, episiotomy, repair of current obstetric laceration, vacuum extraction, forceps delivery) were obtained from the National Hospital Discharge Survey, a nationally representative survey of discharges from short-stay non-Federal hospitals. Approximately 32,000 records for women with deliveries were included in the survey each year. RESULTS: The total rate of all obstetric procedures did not change significantly from 1990 through 2000. However, as during the 1980s, rates increased for induction of labor, vacuum extraction, and repair of current obstetric laceration. Rates decreased for forceps delivery and episiotomy, also continuing 1980s trends. After a long period of increase, the rate of cesarean section declined from 1988 to 1995 but increased again from 1995 to 2000. CONCLUSIONS: Unlike the 1980s, the overall rate of obstetric procedures did not increase from 1990 to 2000, but the mix of obstetric procedures performed continued to change during this period.

Cesarean Section↗
PubMed2002

Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.

OBJECTIVE: To analyze the instrumental deliveries carried out at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia during the year 2000 and compare the outcome of ventouse and forceps deliveries. METHODS: A retrospective case note review of all instrumental deliveries, carried out at the Armed Forces Hospital, Riyadh, during the year 2000. RESULTS: Three hundred and four vaginal deliveries, of whom 258 were ventouse and 46 were forceps deliveries, were assisted. Seventy percent of forceps deliveries were carried out in primigravida as compared to 49% of ventouse deliveries. Fetal distress was the indication in 81.4% of ventouse deliveries as compared to 76% of forceps deliveries. Prolonged 2nd stage of labor was an indication in 11% of forceps and 2.3% of ventouse deliveries. Consultants and Senior Registrars were more likely to use forceps while registrars use ventouse as their preferred instrument for delivery. Attempted ventouse delivery was successful in 91.4% as compared to 95.7% in forceps. Extension of an episiotomy was more likely to occur with ventouse than forceps deliveries while 3rd degree perineal tear occurred more with forceps deliveries. Babies who had attempted ventouse deliveries have lower apgar score at one minute than attempted forceps. No babies required admission to neonatal intensive care unit. There was only one stillbirth in the ventouse delivery group due to intrapartum asphyxia and true knot in the umbilical cord. CONCLUSION: Forceps is more likely to be used in the primigravida and prolonged 2nd stage of labor and less likely to fail. Ventouse is more likely to be used by registrars. Extension of an episiotomy and low apgar score at one minute is more likely to occur with ventouse deliveries.

Adult↗
PubMed1978

Vacuum extraction. Use in a community hospital setting.

The history of vacuum extraction and its use in a specific community hospital setting is reviewed. Basic principles for successful use of the extractor are cited. Two hundred twenty-eight consecutive vacuum extraction cases occurring in an 18-month period are evaluated for indications and outcome. The most common indications were fetal distress, 41.6%; malposition of the vertex 35%; and dysfunctional labor 14.6%. Several subjects exhibited more than one condition influencing the decision to use the extractor. Particular reference is made to the occurrence of significant trauma to the fetal scalp in 18.7% of cases. Careful choice of candidates for vacuum extraction and adherence to principles of application and traction technique are emphasized to reduce the incidence of fetal scalp trauma.

Adolescent↗
PubMed1975

[Some considerations on forceps delivery with excenter handle (author's transl)].

The introduction of electronic monitoring techniques in delivery increasingly has lead to the use of vaginal surgery in delivery. Vacuum and forceps extraction, in our view, do not compete with each other. Years ago forceps extraction was decisively improved by introducing the axial traction forceps. However, we believe that this technique has not been given due attention and is not applied widely enough. In vacuum extraction and in forceps deliveries without axial traction considerable part of the force is exerted in the direction of the symphysis. When using the excentric handle forceps, it is necessary in addition to the traction and pressure components to include the lever action. This is a so-called couple of forces. The additional torque involved in the use of an axial traction forceps shifts the fetal head during extraction in the direction of the hollow of the sacrum. The force needed for this shift and the progression of the head is many times less than that required for conventional forceps extraction. This is due to the absence of the component directed at the symphysis which impedes delivery. The axial traction forceps may also be used in case of the infant's abnormal positioning of the head. In case of a transverse position of the fetal head, a special fastener on the forceps makes it possible to use an excentric handle on the traction hook of the Kielland forceps and thus render possible rotation of the fetal head from the transverse position. The extentric handle in forceps extraction is optimal in order to overcome increased mechanical resistance to delivery. Adjustment of the handles to all types of forceps being used today is possible. From the results mentioned it is clear that the use of the axial traction forceps constitutes a valuable contribution toward declining perinatal mortality rates.

Apgar Score↗
PubMed1996

Nonsurgical removal of a rectal foreign body using a vacuum extractor. Report of a case.

PURPOSE: Rectal foreign bodies can be extracted by nonsurgical methods. However, glass objects require technical considerations to minimize morbidity and may necessitate surgical extraction. We describe a technique that allowed safe transanal extraction of a glass foreign body and avoided laparotomy. METHODS: A patient with a history of a previous rectal foreign body that required laparotomy presented with another incarcerated rectal foreign body. After attempts at manual extraction failed, spinal anesthesia was induced, and an obstetric vacuum extractor was used to transanally withdraw the glass foreign body. RESULTS: The glass foreign body was withdrawn uneventfully using the vacuum extractor. Laparotomy was avoided. The patient was hospitalized for observation and discharged 24 hours later. CONCLUSIONS: Use of the delivery vacuum extractor provided a safe, cost-effective method of glass foreign body removal by the transanal route. Literature review found no other reports of rectal foreign body removal by this method.

Aged↗
PubMed1987

A randomized study of two cups for vacuum extraction.

O'Neil designed a set of suction cups which, because of more efficient lateral pull and greater maneuverability, were claimed to be more efficient and perinatally safer than the Malmström model. These claims were checked by comparing the two instruments in a randomized controlled trial comprising 410 attempted elective extractions. The two instrument groups were comparable at entry and the operators had a similar degree of experience, the sole inter-group difference being the 0.5 cm larger diameter of the O'Neil cups. No significant differences were found between the two types of instrument as to failure rate, incidence of correct cup positioning, and capacity of eliciting internal rotation nor was there a significant divergence in neonatal safety. In a few cases the perineum was lacerated by the traction cord affixed to the O'Neil instrument. The results of this study indicate that the relative advantages and disadvantages of the two cup models are unremarkable.

Extraction, Obstetrical↗
PubMed1987

Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.1%, while forceps use declined from 10.1 to 4.9% over a five-year period. No differences were found in indications for vacuum extraction and forceps, but the preapplication position differed (occiput posterior or transverse in 81.2% in the vacuum group and 27% in forceps patients). Preapplication station also differed, with 59.8% of vacuum extraction at +1 or higher stations, compared with 9% of forceps. Under these conditions we found less maternal trauma, similar failure rates (3.9 versus 2%), and no difference in maternal morbidity. There was a higher incidence of shoulder dystocia and neonatal jaundice in the vacuum group, but cephalohematoma frequency did not differ significantly (3.9% vacuum extraction, 4.3% forceps). Cosmetic injuries (ecchymoses, abrasions) were more likely with vacuum extraction than with forceps (44.1 versus 29.5%). One death occurred in each group. Vacuum extraction replaced midforceps in our institution in the study period. We consider vacuum extraction a useful technique to teach house staff in view of today's decreasing instrumental delivery rate.

Birth Injuries↗