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PubMed1988

Mode of vaginal delivery and epidural analgesia.

A study was carried out on the mode of vaginal delivery in two large groups of parturients: one group comprised 11,264, of whom 0.1% were given epidural analgesia (1977-78) and the other, 10,650, of whom 50% delivered under epidural blockade (1982-83). When the incidence and reasons for instrumental intervention in these two groups were analyzed, it was found that the rate of instrumental delivery was only 1.3% higher (P less than 0.001) in the latter group, which was mainly due to factors not attributable to the epidural blockade. It may be concluded from this survey that epidural analgesia for labor and delivery does not cause an increase in the rate of instrumental delivery.

Anesthesia, Epidural↗
PubMed1978

[The development of Obstetrics at the 2nd Department of Obstetrics and Gynecology, University of Vienna, Medical School, during the last 20 years (author's transl)].

Including the deliveries in 1956, 1961, 1967, 1970, 1971, 1975, 1976 the development of obstetrics at the 2nd Department of Obstetrics and Gynecology, University of Vienna, Medical School, is shown. The frequency of vaginal operative deliveries was reduced, the indicence of ceasarean sections increased from 1.6 to 6.9%. In premature newborns it was possible to gain a higher birthweight, perinatal and postpartum mortality fell from 4.4 to 2.8% and from 3.3 to 1.5% respectively. The connections between these positive results and the new methods and possibilities introduced at the department are discussed.

Austria↗
PubMed1976

Uterine rupture and vacuum extraction.

Eleven uterine ruptures occurred among 11415 vacuum extractions, and these cases are analysed. Cervical tears extending into the lower uterine segment or into the broad ligament occurred in 4 cases, lower segment tears in 6 and a fundal tear in 1. One patient died of respiratory failure. The possible cause of uterine rupture with vacuum extraction appear to be a combination of an unengaged fetal head, an incompletely dilated cervix and an undetected mild cephalopelvic disproportion especially in grandmultiparae, dehiscent or weak uterine scars, prolonged traction without progress, manipulations in shoulder dystocia and obstruction and excessive non controlled traction. Uterine rupture can be minimized by careful selection of cases, proper technique and early recognition of failure.

Extraction, Obstetrical↗
PubMed1976

[Neurologic pathology in children born using vacuum extraction].

In a vacuum extraction 36.2% of the children were born in asphyxia, in 20.9%-with symptoms of disturbed cerebral circulation. In children from the age of 1-7 years-16.3% of them demonstrated pathological signs of the different parts of the nervous system. In this connection the authors suggest a screening by the neurologists during the first days of life of all children born by vacuum extraction.

Birth Injuries↗
PubMed1984

Cranial ultrasound after forceful midpelvis vacuum extraction at term.

The heads of 28 non-hypoxic, full-term infants of normal gravidas delivered by forceful vacuum extraction were examined with ultrasound during the early neonatal period. All echographic findings were normal and all neonates had an uneventful evolution during the first week of life. Addendum: Since this article was completed, a massive intracranial haemorrhage occurred in a non-hypoxic full-term newborn after elective midpelvic vacuum extraction. The intervention was performed by a resident who, despite the guidelines did not call the senior obstetrician after three unsuccessful attempts to extract the fetus. The head was stationed, 2 cm above the level of the ischial spines, not completely flexed with the occiput in the right-anterior position. The newborn died at the age of 3 hours. Autopsy showed a tear of the tentorium cerebelli and the vena cerebri magna.

Brain Injuries↗
PubMed1989

A multicentre randomized trial comparing delivery with a silicone rubber cup and rigid metal vacuum extractor cups.

A total of 258 women requiring assisted delivery where vacuum extraction was thought to be suitable were randomly allocated to delivery with a new silicone rubber cup or metal vacuum extractor cups. There was a tendency for the silicone rubber cup to effect delivery more quickly and to cause less scalp trauma, but to fail to effect delivery on more occasions than metal cups. However, none of these differences was statistically significant. There were no statistically significant differences in the rates of birth canal trauma, maternal blood loss, or neonatal jaundice. The silicone rubber cup produced a cosmetically more acceptable chignon than the metal cups. The introduction of vacuum extractors with silicone rubber cups into obstetric units should be encouraged.

Double-Blind Method↗