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PubMed1995

[Trends in the frequency of obstetrical operations and perinatal mortality in the Czech Republic in comparison with other countries].

In an international epidemiological survey during a 10-year period the increase of obstetric operations was investigated in 11 countries with advanced perinatal care. Major differences were found as regards the frequency of Caesarean sections as well as vaginal operations (forceps and vacuum extraction). The mean effectiveness of the increase in the frequency of Caesarean sections on the reduction (evaluated by the mille drop of perinatal mortality rate is reduced when the frequency of Caesarean section) exceeds about 10%. Of all investigated countries only the Netherlands and the Czech Republic achieve a low perinatal mortality, while the frequency of Caesarean sections is low. The author discusses the reasons for the revealed differences between different countries.

Cesarean Section↗
PubMed1982

Vacuum extraction and neonatal jaundice.

Various fetal scalp lesions are related to the use of the vacuum extractor. Blood sequestered in these lesions could result in an increased bilirubin load on the functionally limited neonatal liver, leading to the development of hyperbilirubinemia. In the present study bilirubin levels of vacuum extracted neonates were compared with those of non-instrumentally delivered babies during the first 72 hours of life. Sixty-nine vacuum extracted neonates had higher bilirubin levels than 56 non-instrumentally delivered babies at 24 (114 mumol/l vs. 96 mumol/l), 48 (163 vs. 141) and 72 (194 vs. 144) hours of age. The p values were 0.05, less than 0.025 and less than 0.001 respectively. This trend was apparent in both oxytocin induced and non-induced deliveries and whether or not phototherapy cases were included in the analysis. The incidence of hyperbilirubinemia requiring phototherapy was higher after vacuum extraction than after non instrumental delivery (27.5% vs. 12.5%; p less than 0.04). Analysis of our results unexpectedly indicated that oxytocin induction was generally associated with an attenuation of bilirubin levels after both vacuum extraction and spontaneous delivery. The clinician attending newborn babies should be aware of the higher incidence of neonatal hyperbilirubinemia associated with vacuum extraction.

Bilirubin↗
PubMed1990

Subaponeurotic haemorrhage in Malaysian neonates.

In a 30-month prospective study, between January 1987 and June 1989, 101 of 64,424 Malaysian neonates (1.6 per 1000 livebirths) born in the Maternity Hospital, Kuala Lumpur were found to have subaponeurotic haemorrhage shortly after delivery. The incidence was highest in neonates weighting 4000 gm or more. There was no significant difference in incidence of this condition in neonates of different ethnic origins. Hypoprothrombinemia was present in only 5/101 (5.0%) of the affected neonates. Sixty seven (66.3%) of the neonates with subaponeurotic haemorrhage had history of trial of vacuum extraction. The incidence of subaponeurotic haemorrhage was significantly higher in neonates delivered by vacuum extraction than by other modes of delivery in this hospital (41.4 per 1000 livebirths in neonates delivered by vacuum extraction versus 1.0 per 1000 livebirths in neonates delivered by other modes). Those neonates who developed subaponeurotic haemorrhage without trial of vacuum extraction had a history of either prolonged labour or difficult delivery. Thirty-three (32.7%) of the neonates with subaponeurotic haemorrhage developed anaemia which required blood transfusion and 3/33 (9.1%) were in shock. Fifty seven (56.4%) of the neonates with subaponeurotic haemorrhage developed hyperbilirubinemia due to the haemorrhage. Four (7.0%) of them had severe unconjugated hyperbilirubinemia which required exchange transfusion. The results of this study suggest that subaponeurotic haemorrhage in Malaysian neonates was commonly associated with vacuum extraction and was not a benign condition.

Extraction, Obstetrical↗
PubMed1988

Kielland's forceps or ventouse--a comparison.

A retrospective study over a 3-year period compared maternal and neonatal outcomes after birth by Kielland's forceps with those by ventouse when there was deep transverse arrest of head. Of the 259 women, 117 were delivered with Kielland's forceps and 142 were delivered with the ventouse. Of the Kielland's forceps deliveries, 15% were performed by a specialist, compared with 41% of the vacuum extractions. There were no differences in maternal morbidity overall, but when groups of operators were compared maternal complications were more frequent in the forceps group with the less experienced operators. There was little early neonatal morbidity (as judged by Apgar score, intubation, admission to the special care baby unit, jaundice and abnormal neurological behaviour) but cephalhaematoma occurred significantly more often in babies born by the ventouse than by Kielland's forceps. There were no perinatal deaths.

Birth Weight↗
PubMed1986

Comparison between the conventional Malmström extractor and a new extractor with Silastic cup.

One hundred women for whom instrumental delivery had to be performed due to fetal asphyxia or uterine inertia were randomized to a vacuum extraction with the conventional Malmström instrument or the Silastic cup of Kobayashi. With the Silastic cup, extraction time was shorter and injuries to the scalp were less common. On the other hand, extraction with the Silastic cup failed more often, especially in occiput posterior position. There were no differences in Apgar scores between the two groups.

Clinical Trials as Topic↗
PubMed1963

[VACUUM EXTRACTOR].

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Extraction, Obstetrical↗
PubMed1986

Forceps or vacuum extraction? A comparison of effects on the newborn infant.

Sixteen women delivered by forceps and 20 women delivered by vacuum extraction (VE) owing to secondary uterine inertia were compared with a control group of 11 women who gave birth spontaneously. The cord arterial pH was lower in the VE group than in the forceps and control groups. Base deficit in both arterial and venous cord blood was greater in the VE group than in the forceps group, probably owing to the longer application and extraction times in VE than in forceps delivery. The incidence of retinal hemorrhage did not differ between the forceps and VE groups. The incidence of cephalhematomata was greater among VE infants than in the forceps and control groups. All infants were examined on the 1st and 5th day by standardized neurological and behavioural examination. There were no significant differences in neurological status between the forceps and VE groups. Thus, in low extraction with no signs of fetal asphyxia, either method can be used with safety if the obstetrician is familiar with both methods of operative vaginal delivery.

Adult↗
PubMed1975

Vacuum extraction.

In the past twenty years, the vacuum extractor has gained wide use in Europe with an associated decrease in perinatal mortality. There, its use is considered by many to be much safet than a forceps delivery. Certain complications are associated with its use, but in general these are minor and transitory. On analysis, most of the serious complications reported in the literature are considered to be due to other associated factors, or to misuse of the vacuum extractor. Experience with the vacuum extractor in the United States has been minimal, and most authors feel that there are few indications for its use. Perhaps it is time that obstetricians in the United States take a more careful look at the European experience, and give the vacuum extractor a fair trial.

Birth Injuries↗