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At least 253 records · Page 14Linked to original sources
PubMed1980

Subgaleal hematoma. A complication of instrumental delivery.

Subgaleal hematomas (SGH) are rare but potentially fatal accumulations of blood beneath the galea aponeurotica of the scalp in the newborn. One hundred twenty-three SGH cases are summarized from the literature. Sixty-four percent occurred after instrumental delivery. The lesion is most often associated with mid-forceps operations (14 cases) and vacuum extraction (60 cases), but SGH also has been recorded after spontaneous vaginal delivery (35 cases) and after cesarean section (11 cases). Intrapartal hypoxia of the fetus and neonatal coagulopathies are prominent features of both spontaneous and instrumental delivery cases. Other risk factors include prematurity, macrosomia, prolonged labor, cephalopelvic disproportion, primiparity, male sex, and African lineage. Mortality for SGH is 22.8%. Early recognition, differentiation from benign cephalohematoma, and prompt treatment by adequate blood replacement and correction of coagulopathies are the major determinants of successful management.

Birth Injuries↗
PubMed1994

[Dual chamber safety vacuum--initial experiences with a new suction cup].

The main problem with vacuum extraction methods, alongside the cephalhaematoma produced, is the premature separation of the suction cup under traction, since the resulting sudden change in pressure can lead to severe intra-cerebral damage to the child. To reduce the risk of vaginal operative delivery, a new double-chamber safety vacuum extractor has been developed by Hepp/King. The basic feature of this instrument is an additional chamber with a thin overlapping area, which surrounds the actual suction cup and serves as a safety vacuum. If the suction cup starts to slip, the external vacuum is released and sounds an alarm. In addition, the inner vacuum has been designed to be convex and to reduce the volume of scalp, which is sucked into the vacuum, thus reducing the size of the cephalhaematoma produced. First experiences in clinical use demonstrated the reliability of the early warning signal, if the direction of traction is false or the applied traction is too strong. The inner vacuum remains constant at 0.8 atu, so that with care, the extraction can continue without interruption. We have used the new instrument in 18 deliveries. In 15 cases, the indication was failure to progress into the second stage of labour; in one case history of retinal detachment and in two cases signs of foetal asphyxia. In all cases, the child was delivered following one or two contractions with traction, without losing the vacuum. The average weight of the newborn was 3566 g. As expected, the cephalohaematoma produced was very much smaller than usual. Further clinical trials are necessary before the value of this new instrument can be assessed.

Asphyxia Neonatorum↗
PubMed1993

Anal sphincter trauma during instrumental delivery.

OBJECTIVES: To determine the incidence of defecatory symptoms, pudendal nerve damage and mechanical trauma to the anal sphincters during vacuum and forceps delivery. METHODS: Anal endosonography, manometry, pudendal nerve terminal motor latency (PNTML) measurements and perineometry were performed in 43 primiparae who had an instrumental delivery (17 vacuum and 26 forceps) and in 47 who had a normal vaginal delivery (controls). RESULTS: Defecatory symptoms developed in 10 (38%) women following a forceps delivery compared with 2 (4%) in the control group (P = 0.0003), and 2 (12%) following a vacuum extraction (P = NS). Anal sphincter defects occurred in 21 (81%) forceps deliveries compared with 17 (36%) controls (P = 0.0005) and 4 (21%) vacuum extractions (P = NS). Anal pressures were lower in those who developed a sphincter defect (P < 0.00001). PNTML was not significantly altered by the mode of delivery. CONCLUSIONS: Compared with vacuum extraction, forceps delivery is associated with significantly more damage to the anal sphincters and hence an increased incidence of defecatory symptoms.

Adult↗
PubMed2005

Guidelines for operative vaginal birth. Number 148, May 2004.

OBJECTIVE: To provide guidelines for operative vaginal birth in the management of the second state of labour. OPTIONS: Nonoperative techniques, episiotomy, and Caesarean section are compared to operative vaginal birth. OUTCOME: Reduced fetal and maternal morbidity and mortality. EVIDENCE: MEDLINE and Cochrane databases were searched using the key words "vacuum" and "birth" as well as "forceps" and "birth" for literature published in English from january 1970 to June 2004. The level of evidence and quality of recommendations made are described using the Evaluation of Evidence from the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: (1) Nonoperative interventions such as one-to-one support, partogram use, oxytocin use, and delayed pushing in women using epidurals will decrease need for operative birth (I-A). (2) Manual rotation may be used alone or in conjunction with instrumental birth with little or no increased risk to the pregnant women or the fetus (III-B). (3) Routine episiotomy is not necessary for an assisted vaginal birth (II-1E). (4) When operative intervention in the second stage of labour is required, the options, risks, and benefits of vacuum, forceps, and Caesarean section much be considered. The choice of intervention needs to be individualized, as one is not clearly safer or more effective than the other (II-B). (5) Failure of the chosen method, vacuum and/or forceps, to achieve delivery of the fetus in a reasonable time should be considered an indication for abandonment of the method (III-C). (6) Adequate clinical experience and appropriate training of the operator are essential to the safe performance of operative deliveries. Hospital credentialing boards should grant privileges for performing these techniques only to an appropriately trained individual who demonstrates adequate skills (III-C). VALIDATION: The Clinical Practice Obstetrics Committee and Executive and Council of the Society of Obstetricians and Gynaecologists of Canada approved these guidelines.

Cesarean Section↗
PubMed1987

Fetal heart rate monitoring during labour--too frequent intervention, too little benefit?

For many obstetricians and midwives continuous electronic fetal heart rate monitoring during labour has replaced the traditional method of intermittent auscultation. Of the eight prospective randomised controlled trials designed to assess its value in obstetric care, four were concerned with mothers defined as being at high-risk, three with normal or low-risk patients, and the eighth with the total population of a maternity hospital over several months. None suggested any major advantage of continuous fetal heart rate monitoring over intermittent surveillance in terms of neonatal mortality, morbidity, cord blood pH values, or the five minute Apgar score. The rates of caesarean section and forceps delivery were higher in the continuously monitored group. For low-risk mothers there is a good case for a return to the traditional method of intermittent auscultation with its lower false-positive rate, lesser incidence of intervention, and opportunity for greater contact between the maternity care staff and the mother.

Cesarean Section↗
PubMed1985

Anaesthesia for suction termination of pregnancy.

The effect of three anaesthetic techniques on blood loss and intra-uterine pressure changes in response to Syntocinon were studied in patients undergoing routine first trimester suction termination of pregnancy. All patients received a standard premedication, a bolus dose of fentanyl, intravenous induction of anaesthesia and maintenance with nitrous oxide and oxygen plus either intravenous supplementation or 0.5% halothane. Intra-uterine pressure was related to the anaesthetic technique used although blood loss was unrelated either to anaesthetic technique or to intra-uterine pressure changes.

Abortion, Induced↗
PubMed1975

[Pregnancy and labor in juvenile primigravidae].

A report is given on 100 juvenile primigravidae delivered in the period from 1965 to 1973. Course of pregnancy, delivery, postpartum period, rate of premature infants, and perinatal mortality are evaluated. EPH gestosis was observed in juvenile primigravidae at a rate approximately twice that encountered in the total number of all pregnant women. This group of patients is characteristic in that intensive care for pregnant women is required in both out-patient and in-patient treatment. In addition, intensive care for pregnant women has the target of minimising the increased rate of premature infants and the associated elevated perinatal mortality.

Adolescent↗