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PubMed2004

Operative vaginal delivery and neonatal and infant adverse outcomes: population based retrospective analysis.

OBJECTIVE: To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries. DESIGN: Population based study. SETTING: US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file. PARTICIPANTS: Singleton live births in the United States (n = 11 639 388) and New Jersey (n = 375 351). MAIN OUTCOME MEASURES: Neonatal morbidity and mortality. RESULTS: Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95% confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and need for assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; > or = 30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery. The sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears. CONCLUSION: Although vacuum extraction does have risks, it remains a safe alternative to forceps delivery.

Cohort Studies↗
PubMed2004

Anal sphincter injury after forceps delivery: myth or reality? A prospective ultrasound study of 93 females.

PURPOSE: This study was designed to estimate the prevalence of anal sphincter injury after forceps delivery in a large population of females managed by trained obstetricians in a French hospital and to identify factors predictive for anal sphincter injury. METHODS: We performed a prospective study of healthy females older than 18 years with no history of anal incontinence, anorectal abnormalities, or anorectal surgery after their first vaginal delivery. All females were interviewed using a standardized questionnaire concerning intestinal transit and continence status. Physical examination and endoanal ultrasonography were performed after delivery. RESULTS: Between November 1999 and November 2000, 93 females were included in the study after their first forceps delivery. Eleven patients (11.8 percent) had a partial defect involving the external sphincter, visible on ultrasonography. One patient (1.1 percent) had a partial defect of external sphincter with complete defect of internal sphincter (sequelae of primary repair of a third-degree perineal tear). Seventeen patients (18.2 percent) had flatus incontinence, and four patients (4.3 percent) had liquid stool incontinence. A high daily number of stools was significantly associated with sphincter defect visible on ultrasonography (P=0.02). The development of anal incontinence was not related to sphincter defect on ultrasonography. There was a strong association between perineal tear and sphincter defect visible on ultrasonography (odds ratio, 4.5 (range, 1.2-16.7)). CONCLUSIONS: Anal sphincter injury after forceps delivery was identified in <13 percent of our large population of healthy females. Our study does not confirm previous observations that anal sphincter injury is common after forceps delivery; previously published studies may have overestimated the prevalence of this condition. The only factor with significant predictive value for anal sphincter injury was perineal tear. Anal endosonography should be recommended after obstetric perineal tear.

Adult↗
PubMed2002

Forceps delivery.

This chapter reviews the role for instrumental delivery in current practice and gives a critical account of current techniques of operative vaginal delivery by forceps. Important issues, including case choice, documentation, forceps application, avoidance of complications, and training and education are included.

Extraction, Obstetrical↗
PubMed1990

[Painless labor and instrumentation].

This report is a retrospective study of painless labor and its relation to the instrumentation. It consists of 200 cases of primigravida in labor. In the study group, 100 consecutive cases of primigravida receiving painless labor was chosen and compared to another 100 consecutive primigravida in labor without receiving painless labor. We found that painless labor with epidural analgesia would decrease the rate of cesarean section, but increase the frequency of using forceps and vacuum for labor. The rate of normal spontaneous delivery is low as compared with those not receiving epidural analgesia for painless labor. However, painless labor bears no relation to the labor course nor discernible significance to the Apgar Score of the newborn babies. We strongly recommend painless labor to those poor pain tolerated primigravida.

Adult↗
PubMed1987

Vacuum extraction versus forceps delivery: indications and complications, 1979 to 1984.

Two hundred fifty-six vacuum extractions and 300 randomly chosen forceps deliveries were analyzed retrospectively. Vacuum extraction use increased from 0.3 to 3.1%, while forceps use declined from 10.1 to 4.9% over a five-year period. No differences were found in indications for vacuum extraction and forceps, but the preapplication position differed (occiput posterior or transverse in 81.2% in the vacuum group and 27% in forceps patients). Preapplication station also differed, with 59.8% of vacuum extraction at +1 or higher stations, compared with 9% of forceps. Under these conditions we found less maternal trauma, similar failure rates (3.9 versus 2%), and no difference in maternal morbidity. There was a higher incidence of shoulder dystocia and neonatal jaundice in the vacuum group, but cephalohematoma frequency did not differ significantly (3.9% vacuum extraction, 4.3% forceps). Cosmetic injuries (ecchymoses, abrasions) were more likely with vacuum extraction than with forceps (44.1 versus 29.5%). One death occurred in each group. Vacuum extraction replaced midforceps in our institution in the study period. We consider vacuum extraction a useful technique to teach house staff in view of today's decreasing instrumental delivery rate.

Birth Injuries↗
PubMed1993

Health after childbirth: a comparison of normal and assisted vaginal delivery.

413 women were included in the study: 100 who had had a normal delivery and 313 who had participated in a randomised controlled comparison of forceps or ventouse delivery. The study comprised a questionnaire and assessment at 24-48 hours after delivery and a questionnaire in the second year after delivery. There was significantly more morbidity in the women in the instrumental delivery group compared to women in the normal delivery group at both the early assessment and long-term follow-up.

Adult↗
PubMed2004

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↗
PubMed1988

Cord blood acid-base status in neonates delivered by Silastic vacuum cup extraction: comparison with forceps and spontaneous deliveries.

Umbilical cord blood gases were measured as objective parameters of neonatal outcome in patients delivered by Silastic vacuum extractor and were compared with those values from patients delivered spontaneously, by forceps, or by sequential use of vacuum and forceps. The results demonstrated no clinically significant differences among the groups in cord blood pH, pCO2, pO2, base excess, or bicarbonate values. These observations provide reassurance that the Silastic vacuum extractor is a safe alternative for vaginal delivery of the appropriately selected term fetus.

Acid-Base Equilibrium↗
PubMed1995

Vacuum-assisted delivery.

The literature seems to allow certain general conclusions regarding the choice of instrument for assisted vaginal delivery. Both forceps and vacuum extraction offer certain advantages and drawbacks. Forceps are more difficult to apply, more prone to potentially significant facial injuries, require generally better maternal analgesia, and are associated with increased maternal soft tissue trauma. Vacuum extractors in general are easier to apply, are more likely to result in scalp trauma, and may be associated with increased rates of intracranial trauma. It seems likely that factors particular to each patient may play a significant role in the genesis of delivery associated with maternal and neonatal morbidity. Because of the ease of application, vacuum extractors may be used potentially in circumstances in which forceps assistance would not be attempted, allowing an operator of average experience to perform rotational deliveries. The use of vacuum extraction does appear to decrease the incidence of cesarean section in delivery populations. Given the apparent association between difficult assisted deliveries and increased neonatal morbidity, it is incumbent on the operator to attempt delivery only when vaginal delivery seems to be a safe option. Furthermore, the operator in such circumstances must be willing to reassess the attempt if initial attempts are not met with success. The minimal rates of significant intracranial injury associated with vacuum extraction in randomized studies of the method demonstrate the relative safety of the vacuum extraction when used judiciously. The ultimate choice of the route of delivery and method of assisted delivery should reflect a consideration of the fetal station, presentation, and maternal and fetal circumstances. It is hoped that further investigations in this area may clarify some of the issues discussed in this article.

Birth Injuries↗
PubMed1979

Neonatal retinal hemorrhages and influence of perinatal factors.

We studied fundus oculi in 234 newborns, divided into two groups of mothers and neonates with or without disease. The overall frequency or retinal hemorrhages was 30.3% (71 neonates). In each group, we studied the association between retinal hemorrhage and several variables of labor and the newborn infant. Statistically significant differences were found in the incidence of hemorrhage in one (2.6%) neonate born by cesarean section, as compared with 61 (38%) spontaneous or 9 (25%) forceps delivery.

Birth Injuries↗
PubMed1984

Should a paediatrician be present at non-rotational forceps deliveries?

In a series of 500 consecutive deliveries there were 35 non-rotational forceps deliveries for delay in the second stage of labour. There was no statistically significant difference in the frequency of resuscitations in this group compared with that in 329 spontaneous vertex deliveries. It is concluded that a paediatrician need not be called routinely to these forceps deliveries when there is no evidence of fetal distress.

Female↗
PubMed1975

Practitioners'--breeders' approach to canine parturition.

Both veterinary surgeon and dog breeder should be involved in assessing the whelping capability of brood bitches as one essential point in the selection of sound stock. Normal parturition is described in a manner that might be used in the instruction of breeders and nursing auxiliaries in midwifery. In its classical three stages, the mechanics and hydraulics are explained in simple terms and the hormonal changes discussed in relation to each stage. The type of co-operation desired between veterinary surgeon and breeder is discussed and the instruction to be given on the recognition of dystocia is outlined. Some commonly met dystocias are described. Simple digitally-assisted delivery by the midwife/breeder is described as are the forceps techniques which may be applied by the veterinary surgeon in the course of diagnosis and delivery.

Animals↗
PubMed2004

Vacuum-assisted delivery: a review.

In 1992, the number of vacuum deliveries overtook the number of forceps deliveries performed in the USA. Most clinical experiences report that the vacuum is safe for both the fetus and the mother when used properly. Correct cup placement on the fetal head and knowing when to abandon the procedure, appear to be key components to conducting a safe and successful vacuum delivery. However, the focus and training that has been afforded forceps deliveries in the past has not been given to the vacuum, because of its perceived 'ease of use'. This apparent lack of understanding has led to increasing numbers of complications associated with its use. In addition, because forceps are being taught less in training programs, fewer and fewer physicians are being trained in the essential skills of operative vaginal delivery. This review is intended to emphasize the correct techniques and skills of vacuum-assisted vaginal delivery in an attempt to increase the success and decrease the complications associated with its use.

Birth Injuries↗
PubMed1999

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↗
PubMed1983

Forum. Epidural analgesia and forceps delivery: laying a bogey.

The spontaneous and operative delivery rates on a labour ward are compared in the years before and after the initiation of an epidural analgesia service. An epidural rate of 27% of all deliveries in the first year is the only influence affecting an otherwise almost steady obstetric background. Despite this major impact, the changes in operative delivery rates are small and fail to reach statistical significance, although the decrease in spontaneous deliveries is significant. In later years the epidural rate rose to involve 72% of primiparae and 26% of multiparae, yet the pattern of deliveries tended to return toward the pre-epidural picture.

Anesthesia, Epidural↗
PubMed2004

Immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries.

OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliveries that occurred from January 1, 1998, to August 30, 1999, at Winthrop-University Hospital. Maternal demographics and delivery characteristics were recorded. Maternal outcomes, such as use of episiotomy and presence of lacerations, were studied. Neonatal outcomes evaluated were Apgar scores, neonatal intensive care unit admissions, cephalohematomas, instrument marks and bruising, and caput and molding. RESULTS: Of 508 operative vaginal deliveries, 200 were forceps and 308 were vacuum assisted. Forceps were used more often than vacuum for prolonged second stage of labor (P =.001). There was a higher rate of epidural (P =.02) and pudendal (P <.001) anesthesia, episiotomies (P =.01), maternal third- and fourth-degree perineal (P <.001) and vaginal lacerations (P =.004) with the use of forceps, whereas periurethral lacerations were more common in vacuum-assisted (P =.026) deliveries. More instrument marks and bruising (P <.001) were found in the neonates delivered by forceps, whereas there was a greater incidence of cephalohematomas (P =.03) and caput and molding (P <.001) in the neonates delivered with vacuum. Multivariable logistic regression analysis showed that forceps use was associated with an increase in major perineal and vaginal tears (odds ratio [OR] 1.85; 95% confidence interval [CI] 1.27, 2.69; P =.001), an increase in instrument marks and bruising (OR 4.63; 95% CI 2.90, 7.41; P <.001) and a decrease in cephalohematomas (OR 0.49; 95% CI 0.29, 0.83; P =.007) compared with the vacuum. CONCLUSIONS: Maternal injuries are more common with the use of forceps. Neonates delivered with forceps have more facial injuries, whereas neonates delivered with vacuum have more cephalohematomas. LEVEL OF EVIDENCE: II-3

Adult↗