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At least 487 records · Page 27Linked to original sources
PubMed2001

Risk of new-onset urinary incontinence after forceps and vacuum delivery in primiparous women.

OBJECTIVE: We sought to determine the incidence of new-onset urinary incontinence after forceps and vacuum delivery compared with spontaneous vaginal delivery. STUDY DESIGN: We performed a prospective study in primiparous women delivered by forceps (n = 90), vacuum (n = 75), or spontaneous vaginal delivery (n = 150). Follow-up for urinary incontinence was at 2 weeks, 3 months, and 1 year after delivery. RESULTS: The incidence of urinary incontinence was similar in the 3 groups at 2 weeks after delivery. The proportion of women developing new-onset urinary incontinence decreased significantly over time in the spontaneous vaginal (P =.003) and vacuum delivery groups (P =.009) but not in the forceps group (P =.2). No relationship of urinary incontinence with vaginal lacerations, epidural anesthesia, length of second stage of labor, or infant birth weight was seen. CONCLUSIONS: In primiparous women, urinary incontinence after forceps delivery is more likely to persist compared with spontaneous vaginal or vacuum delivery.

Adult↗
PubMed2001

Morbidity of first trimester aspiration termination and the seniority of the surgeon.

Vacuum aspiration is a safe, acceptable, and efficacious method of first trimester pregnancy termination. The success and complication rates are thought to be partially dependent on operator experience and gestation. We examined this further by studying the outcome of 828 consecutive surgical abortions up to 13 weeks gestation in our hospital. The following outcomes were measured: surgical curettage for presumed retained products of conception; continuing pregnancy; uterine perforation; pelvic sepsis requiring intravenous antibiotics; and blood transfusion required. The complete abortion rate was 94.6% and the rate of continuing pregnancy 0.24%. There was a significant relationship between efficacy and seniority of the surgeon; consultants, senior registrars, registrars, and senior house officers had complete abortion rates of 97.8, 92.8, 94.7, and 88.4% respectively (P = 0.039). Parity did not affect efficacy. Terminations at 12-13 weeks gestation were associated with a significantly lower complete abortion rate. The rates of uterine perforation, blood transfusion, pelvic sepsis requiring intravenous antibiotics, and overnight hospital admission were 0.24, 0, 0.97, and 1.69% respectively. Thus, the only significant factors affecting outcome of surgical abortion are grade of operating surgeon or terminations performed at later gestations of 12-13 weeks. It is vital that physicians performing surgical terminations are adequately trained.

Abortion, Induced↗
PubMed2004

Paracervical block in incomplete abortion using manual vacuum aspiration: randomized clinical trial.

OBJECTIVE: To estimate the effectiveness of paracervical block in controlling pain among women treated with manual vacuum aspiration for an incomplete abortion METHODS: A randomized clinical trial was conducted at Nuestra Señora de Altagracia, a maternal and perinatal referral hospital in the Dominican Republic. The sample size was based on a clinical difference of 1.5 points in the level of pain measured with the visual analog scale using 90% power and a sampling error of 0.04. Women who were at 12 weeks of gestation or less with an incomplete abortion were eligible to participate. They were randomly assigned to receive either the standard treatment of care (manual vacuum aspiration for uterine evacuation with psychological support but no paracervical block) or manual vacuum aspiration treatment with psychological support and paracervical block using 1.0% lidocaine. Patients with active infections, severe illnesses, psychiatric disorders, or allergies to lidocaine were excluded. Intraoperative pain as reported by the women and as documented by an external observer was measured. RESULTS: Although the paracervical block technique used showed a slight reduction in severe pain, there were no clinically or statistically significant differences in intraoperative pain between the 2 groups (relative risk 0.73; 95% confidence interval 0.43, 1.23) with 50% of all patients registering 7 or higher score on a visual analog pain scale of 0-10. However, statistically significant differences were found in each group when comparing the level of preoperative and intraoperative pain described by the patient (P <.001). The manual vacuum aspiration technique and the paracervical block were not accompanied by complications. CONCLUSION: The paracervical block technique used in this study along with psychological support was comparable with pain control using psychological support alone; neither pain management regimen provided sufficient pain control. It is recommended that randomized comparative studies be designed to determine the effectiveness of other paracervical block techniques and the efficacy of the use of analgesics in patients suffering from incomplete abortion treated with manual vacuum aspiration.

Abortion, Incomplete↗
PubMed2006

Outcomes of pregnancy beyond 37 weeks of gestation.

OBJECTIVE: The aim of the study was to evaluate pregnancy outcomes by weeks of gestation. A second aim was to assess the outcomes in groups with spontaneous or induced labor. METHODS: This was a prospective cohort study of singleton pregnancies delivered after 37 weeks of pregnancy covering a well defined region in Norway from 1990 to 2001 (N = 27,514). Linear regression, chi 2 tests, and multivariable logistic regression analysis were used. RESULTS: Maternal complications varied with gestational age, and were lowest at 39 weeks and highest postterm (cesarean delivery 12.3-21.6%, operative vaginal delivery 10.7-15.4%, maternal hemorrhage 9.7-14.6%). Poor neonatal outcome varied with gestational age only for spontaneous labors (Apgar at 5 minutes less than 7 1.0-2.3%, pH less than 7.10 3.4-5.2%), whereas induction of labor was a risk factor for delivery complications (odds ratio 1.3-2.8), independent of gestational weeks. CONCLUSION: Poor pregnancy outcomes vary with gestational age. Postterm pregnancy and induced labor are prognostic factors for poor outcome.

Adult↗
PubMed2006

Vacuum-assisted delivery: an analysis of traction force and maternal and neonatal outcomes.

Safety recommendations for vacuum-assisted delivery focus on limiting the number of pulls and the duration of the procedure. With the introduction of the Kiwi OmniCup vacuum extractor incorporating a Traction Force Indicator, it is now possible to reliably monitor and control the amount of traction force exerted on the fetal scalp. The OmniCup was used in a prospective observational study of 119 vacuum-assisted deliveries in nulliparous women to establish practical guidelines for safe practice in typical clinical settings.

Adult↗
PubMed2004

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review.

OBJECTIVE: To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. DATA SOURCES: Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. STUDY SELECTION: Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. DATA SYNTHESIS: Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). CONCLUSIONS: Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.

Analgesia, Epidural↗
PubMed1998

Reported comfort with obstetrical emergencies before and after participation in the advanced life support in obstetrics course.

BACKGROUND AND OBJECTIVES: Prior research has demonstrated a change in Advanced Life Support in Obstetrics (ALSO) course attendees' reported comfort with managing specific obstetrical emergencies and procedures before and immediately after participation in an ALSO course. Assessment of longer-term stability of these changes has not been performed. This study measured changes in comfort with obstetrical emergencies and reported practice patterns 1 year after ALSO training. METHODS: ALSO course attendees (275) were given a grounded Likert scale survey measuring reported comfort with the management of specific obstetrical emergencies and procedures before, immediately after, 6 months after, and 1 year after participation in an ALSO course. Practice patterns were also surveyed. Paired data were analyzed using the Kruskal-Wallis one-way ANOVA test at a 95% confidence interval for two-tailed significance. RESULTS: ALSO course participants reported a significant increase in their comfort with the management of each of 15 obstetrical emergencies and procedures taught in the ALSO curriculum. Reported comfort remained high at 6 months' and 1-year follow-up and was accompanied by a statistically significant change in reported practice patterns; more participants performed, in their practice 1 year after completion of ALSO training, amnioinfusion, vacuum-assisted vaginal delivery, and ultrasound for determining fetal position and placental location. CONCLUSIONS: Affective learning is important in translating knowledge and skills into the practice of medicine. Our study demonstrates that participation in the ALSO course increases participants' knowledge in the affective domain of learning.

Amnion↗
PubMed2003

What to do after a failed attempt of vacuum delivery?

OBJECTIVES: To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery. STUDY DESIGN: A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4). RESULTS: Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups. CONCLUSIONS: If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.

Adult↗
PubMed1994

Pneumomediastinum in labor.

We describe pneumomediastinum in a primigravida with delay in the second stage of labor. The pathophysiology, clinical presentation, and management are reviewed.

Adult↗
PubMedDate not supplied

[Peripartum cardiomyopathy--Obstetric emergency for mother and child].

This case report describes the diagnosis, treatment as well as maternal and fetal outcome of a pregnancy complicated by peripartum cardiomyopathy (PPCM). The article demonstrates criteria that define peripartum cardiomyopathy using clinical and echocardiographic features. In absence of preexisting heart disease an acute left ventricular dysfunction of the mother led to fetal bradycardia and immediate delivery. We discuss possible causes, clinical management and long term outcome in respect of the available literature. Future pregnancies should be avoided with at least 50 % risk of recurrence.

Adult↗
PubMed1990

International differences in the use of obstetric interventions.

This study investigated current levels and trends between 1975 and 1986 in the rates of cesarean section in 21 countries and of operative vaginal delivery in 14 countries. Sharp differences in national obstetric practice were found, with cesarean rates ranging from a high of 32 (Brazil) to 7 (Czechoslovakia) per 100 hospital deliveries, and operative vaginal rates from 16 (Canada) to 2 (Czechoslovakia) per 100 hospital deliveries. For most countries, rates of cesarean section have risen as operative vaginal rates have fallen, but some important exceptions exist. A comparison of cesarean section rates for two complications of labor and delivery that can be objectively diagnosed, multiple births and breech delivery, demonstrates that cesarean section rates for these complications rose sharply in almost every country from 1980 to 1985. A comparison of 1985 national rates of intervention and measures of birth outcome found no significant relationship between the two. While such ecological comparisons are imperfect at best, this does indicate that low levels of early infant mortality can be achieved in some populations despite a low rate of cesarean deliveries.

Australia↗