ACOG committee opinion. Delivery by vacuum extraction. Number 208, September 1998. Committee on Obstetric Practice. American College of Obstetricians and Gynecologists.
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Results for “Vacuum Extraction, Obstetrical”
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Risk factors for obstetrical anal sphincter lacerations.
The objective of this study was to identify the rate of anal sphincter lacerations in a large population-based database and analyze risk factors associated with this condition. Data were obtained from Pennsylvania Healthcare Cost Containment Council (PHC4) regarding all cases of obstetrical third and fourth degree perineal lacerations that occurred during a 2-year period from January 1990 to December 1991. Modifiable risk factors associated with this condition were analyzed, specifically episiotomy, forceps-assisted vaginal delivery, forceps with episiotomy, vacuum-assisted vaginal delivery, and vacuum with episiotomy. There were a total of 168,337 deliveries in 1990 and 165,051 deliveries in 1991 in Pennsylvania. Twenty-two percent (n = 74,881) of the deliveries were by cesarean section and were excluded from analysis. Among the remaining 258,507 deliveries, there were 18,888 (7.3%) third and fourth degree lacerations. Instrumental vaginal delivery, particularly with use of episiotomy, increased the risk of laceration significantly [forceps odds ratio (OR): 3.84, forceps with episiotomy OR: 3.89, vacuum OR: 2.58, vacuum with episiotomy OR: 2.93]. Episiotomy on the whole was associated with a threefold increase in the risk of sphincter tears. However, episiotomy in the absence of instrumental delivery seems to be protective with an OR of 0.9 [95% confidence interval (CI): 0.88-0.93]. Instrumental vaginal delivery, particularly forceps delivery, appears to be an important risk factor for anal sphincter tears. The risk previously attributed to episiotomy is probably due to its association with instrumental vaginal delivery. Forceps delivery is associated with higher occurrence of anal sphincter injury compared to vacuum delivery.
Adolescent↗
A comparison of single prostaglandin E2 vaginal tablet with prostaglandin E2 vaginal pessaries for induction of labor at term.
This study represents the first of its kind in Kuwait. Two preparations of prostaglandin E2 (PGE2) have been compared as agents for induction of labor. In a randomized controlled study of 200 women of low parity and unfavorable cervical induction features induction of labor by means of a single vaginal tablets of PGE2 was compared with locally prepared PGE2 vaginal pessaries. The gradual increase of uterine contractions and the establishment of labor in a similar way to that observed during spontaneous labor was more apparent after PGE2 tablets. Labor induction was successful in 80% of patients in PGE2 tablet group compared with 59% in PGE2 pessaries group. The incidence of cesarean section was equal in both groups (4%), but none was performed due to uterine hyperactivity. The data presented indicate that the PGE2 vaginal tablet is safe and effective in induction of labor in healthy women at term.
Administration, Intravaginal↗
Worldwide survey of assisted vaginal delivery.
OBJECTIVES: To ascertain which instruments are most commonly used for assisted vaginal delivery. METHODS: A postal survey in which 1411 questionnaires were sent to major obstetric centers worldwide. RESULTS: Over 60% (305/508) of the respondents indicated willingness to participate in a multicenter randomized controlled trial between the two instruments. CONCLUSIONS: The forceps remained popular in most of the 'English-speaking' countries, as well as in Eastern Europe and South America. The ventouse was most popular in Africa, Asia and Northern Europe.
Data Collection↗
Operative vaginal delivery: a comparison of forceps and vacuum for success rate and risk of rectal sphincter injury.
OBJECTIVE: We investigated the success rate of operative vaginal delivery and risk of rectal sphincter injury when forceps or vacuum was used. STUDY DESIGN: Cases were identified by a retrospective review of delivery logbooks and an obstetric database. Rotations were excluded. Failure was defined as inability to deliver the fetus with the initial instrument. Rectal injury was defined as third- or fourth-degree laceration. Institutional review board approval was obtained. P-value of less than .05 was considered significant, and odds ratios (OR) were calculated when appropriate. RESULTS: Data were obtained for 1802 deliveries: 1438 occiput anterior and 364 occiput posterior positions. For occiput anterior position, rectal sphincter injury with forceps was 53.8% and vacuum 26.6% (P < .0001, OR 3.25). Failure rate with vacuum was 6.3% and forceps 0.9% (P < .0001, OR 7.53). For occiput posterior position, rectal injury with forceps was 71.6% and vacuum 33.1% (P < .0001; OR 5.25). Failure rate with vacuum was 33.0% and with forceps 13.6% (P < .0001, OR 3.15). For occiput posterior position, failure rate at mid position with vacuum was 71.4%, and forceps 16.7% (P < .001, OR 12.5). Failure rate at low position with vacuum was 30.8%, and forceps 12.5% (P < .001, OR 3.14). Failure rate with vacuum at mid position was higher than at low position (P < .0001, OR 5.57). Failure rate with forceps at mid and low positions was not significantly different. There was no difference in failure rate between vacuum and forceps at the outlet position. CONCLUSIONS: For both occiput anterior and posterior cases, the use of forceps was associated with a higher success rate than the vacuum, but with greater risk of rectal sphincter injury. The use of either vacuum or forceps from the occiput posterior position was associated with a higher likelihood of rectal injury and lower likelihood of vaginal delivery when compared with the occiput anterior position.
Anal Canal↗
Does epidural analgesia prolong labor and increase risk of cesarean delivery? A natural experiment.
OBJECTIVE: More than 50% of pregnant women in the United States are using epidural analgesia for labor pain. However, whether epidural analgesia prolongs labor and increases the risk of cesarean delivery remains controversial. STUDY DESIGN: We examined this question in a community-based, tertiary military medical center where the rate of continuous epidural analgesia in labor increased from 1% to 84% in a 1-year period while other conditions remained unchanged-a natural experiment. We systematically selected 507 and 581 singleton, nulliparous, term pregnancies with spontaneous onset of labor and vertex presentation from the respective times before and after the times that epidural analgesia was available on request during labor. We compared duration of labor, rate of cesarean delivery, instrumental delivery, and oxytocin use between these two groups. RESULTS: Despite a rapid and dramatic increase in epidural analgesia during labor (from 1% to 84% in 1 year), rates of cesarean delivery overall and for dystocia remained the same (for overall cesarean delivery: adjusted relative risk, 0.8; 95% confidence interval, 0.6-1.2; for dystocia: adjusted relative risk, 1.0; 95% confidence interval, 0.7-1.6). Overall instrumental delivery did not increase (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.4), nor did the duration of the first stage and the active phase of labor (multivariate analysis; P >.1). However, the second stage of labor was significantly longer by about 25 minutes (P <.001). CONCLUSION: Epidural analgesia during labor does not increase the risk of cesarean delivery, nor does it necessarily increase oxytocin use or instrumental delivery caused by dystocia. The duration of the active phase of labor appears unchanged, but the second stage of labor is likely prolonged. (Am J Obstet Gynecol 2001;185:128-34).
Adult↗
Trends in operative vaginal delivery rates and associated maternal complication rates in an inner-city hospital.
OBJECTIVE: The aims of this study were to determine trends in operative vaginal delivery rates in a large inner-city hospital and to assess associated risks. STUDY DESIGN: We performed a retrospective cohort study (1980-1996) of women with singleton term pregnancies who underwent operative vaginal delivery at Grady Memorial Hospital, Atlanta. Maternal complication rates were compared between forceps-assisted and vacuum-assisted methods. RESULTS: There was a decline in forceps-assisted deliveries during the 1980s and an increase during the 1990s. The vacuum-assisted delivery rate was exceedingly low during the 1980s and increased during the 1990s. Women who underwent forceps-assisted delivery were more likely to be <24 years old, to be nulliparous, and to have had regional anesthesia, midline episiotomies, and infant presentations other than occipitoanterior (P <.001). Women who underwent forceps-assisted deliveries had increased risks of postpartum infection, cervical laceration, prolonged hospital stay, perineal laceration, and postpartum complications. CONCLUSION: There were upward trends in the rates of operative vaginal delivery at this inner-city hospital. Women who underwent forceps-assisted delivery had greater rates of maternal complications than did those who underwent vacuum-assisted delivery.
Adult↗
Chart documentation of informed consent for operative vaginal delivery: is it adequate?
OBJECTIVES: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery. STUDY DESIGN: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation of associated risks, general consent for the procedure, indication, and option of cesarean delivery (CD). RESULTS: Three hundred forty six charts were reviewed: 246 were excluded for an emergency delivery (19%), misclassification (25%), or lost notes (27%). In the remaining 100 cases, 61% had a general consent for instrumented vaginal delivery. Documentation of any maternal or neonatal risks was found in 3% and 0%, respectively. The option of a cesarean delivery was documented in 22% of the cases. When comparing 5-year time intervals before and after 2000, there was no increased frequency in documentation of maternal or neonatal risks. CONCLUSIONS: Documentation of informed consent for instrumented vaginal delivery is inconsistent and should be improved.
Consent Forms↗
A randomized prospective study comparing delivery with metal and silicone rubber vacuum extractor cups.
OBJECTIVE: To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups. DESIGN: Prospective randomized controlled study. SETTING: A busy referral maternity hospital in Kathmandu, Nepal. SUBJECTS: 101 women were assigned to delivery with the Silc-cup and 98 to delivery with the metal cup. MAIN OUTCOME MEASURES: Success rate at achieving delivery with the assigned instrument and incidence of neonatal trauma. Analysis was by 'intention to deliver' with women remaining in their original group regardless of the eventual mode of delivery. RESULTS: Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc-cup 85% and metal cup 87%). The Silc-cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc-cup group (22%), compared with the metal cup group (37%). CONCLUSIONS: The data indicate a greater tendency for the Silc-cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.
Adult↗
A randomized prospective study comparing the new vacuum extractor policy with forceps delivery.
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Female↗
Choice and instrumental delivery.
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Attitude of Health Personnel↗
Choice and instrumental delivery.
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Attitude of Health Personnel↗
Choice and instrumental delivery.
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Delivery, Obstetric↗
Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse.
OBJECTIVE: To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study. DESIGN: Follow up of a randomised controlled trial. SETTING: District general hospital in the West Midlands. POPULATION: Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n = 115) and vacuum extractor (n = 113). MAIN OUTCOME MEASURES: Bowel and urinary dysfunction, child vision assessment, and child development. RESULTS: Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97, 95% CI 0.38-2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups. CONCLUSIONS: There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.
Adult↗
A prospective randomised controlled trial of the Kiwi Omnicup versus conventional ventouse cups for vacuum-assisted vaginal delivery.
OBJECTIVE: To evaluate the performance and safety of the Kiwi Omnicup and compare it to conventional vacuum cups in routine clinical practice. DESIGN: A randomised controlled trial of the Kiwi Omnicup versus conventional vacuum cups. SETTING: Queen Charlotte's and Chelsea Hospital, a tertiary referral hospital in London from April 2001 to March 2004. POPULATION: Women requiring assisted vaginal delivery by ventouse. METHODS: Women were randomised to the Kiwi Omnicup (n=206) or conventional vacuum cups (n=198). Data regarding maternal demographics, labour, mode of delivery and maternal and neonatal outcome were collected. MAIN OUTCOME MEASURES: Failure of delivery with instrument of first choice. RESULTS: The Kiwi Omnicup was less successful at delivery with instrument of first choice than the conventional ventouse, failure rate 30.1 versus 19.2% (RR 1.58; 95% CI 1.10-2.24). It was associated with a greater number of cup detachments (mean 0.68 compared with 0.28, with 44% compared with 18% having at least one detachment [P<0.0001]). There was no difference in the incidence of severe maternal trauma, and there were no cases of serious neonatal injury. CONCLUSIONS: The Kiwi Omnicup is less successful than conventional ventouse in achieving vaginal delivery, but its safety profile is comparable.
Adult↗
Outcomes after vacuum-assisted deliveries. Births attended by community family practitioners.
OBJECTIVE: To assess success rates, modes of delivery following failure, complications of mothers and newborns, and effect of extractor station and parity on vacuum-assisted deliveries attended by family physicians. DESIGN: Retrospective audit. SETTING: Community hospital. PARTICIPANTS: Thirty-five family physicians providing maternity care. MAIN OUTCOME MEASURES: Complications, parity, and extractor station of 153 vacuum-assisted deliveries from April 1, 2000, to March 31, 2003. RESULTS: Family physicians attempted 153 vacuum deliveries (82 at low station, 71 at outlet station) and had a 94.1% success rate. Of nine failed vacuum deliveries (eight at low station and one at outlet station), four were subsequently delivered by forceps and five by cesarean section. Except for one case of subdural hematoma, complications were few. Nulliparity was associated with six of the nine failed vacuum deliveries. CONCLUSION: Family physicians were usually successful with vacuum-assisted deliveries. Complications were infrequent and rapidly resolved, but one failure, which was followed by a failed forceps delivery and eventual cesarean section, resulted in a serious complication. Low station and nulliparity were associated with failure of vacuum-assisted deliveries.
Adult↗