On forceps delivery and factors influencing its results.
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Adult↗
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Results for “OBSTETRICAL FORCEPS”
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Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity.
To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Ala Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction (caput, jaundice, cephalohaematoma). Serous neonatal morbidity was rare for both groups.
Adult↗
The effect of sequential use of vacuum and forceps for assisted vaginal delivery on neonatal and maternal outcomes.
OBJECTIVE: To determine the risk of neonatal and maternal disease associated with the sequential use of vacuum and forceps compared with spontaneous vaginal delivery. STUDY DESIGN: Using Washington state birth certificate data linked to hospital discharge records, we compared 3741 vaginal deliveries by both vacuum and forceps, 3741 vacuum deliveries, and 3741 forceps deliveries to 11,223 spontaneous vaginal deliveries. RESULTS: Compared with spontaneous vaginal deliveries, deliveries by sequential use of vacuum and forceps had significantly higher rates of intracranial hemorrhage (relative risk [RR], 3.9; 95% confidence interval [CI], 1.5 to 10.1), brachial plexus (RR, 3.2; 95% CI, 1.6 to 6.4), facial nerve injury (RR, 13.3; 95% CI, 4.7 to 37.7), seizure (RR, 13.7; 95% CI, 2.1 to 88.0), depressed 5-minute Apgar score (RR, 3.0; 95% CI, 2.2 to 4.0), assisted ventilation (RR, 4.8; 95% CI, 2.1 to 11.0), fourth-degree (RR, 11.4; 95% CI, 6.4 to 20.1 among multiparous women) and other lacerations, hematoma (RR, 6.2; 95% CI, 2.1 to 18.1 among multiparous women), and postpartum hemorrhage (RR, 1.6; 95% CI, 1.3 to 2.0). The relative risk of sequential vacuum and forceps use was greater than the sum of the individual relative risks of each instrument for intracranial hemorrhage, facial nerve injury, seizure, hematoma, and perineal and vaginal lacerations. CONCLUSION: Sequential use of vacuum and forceps is associated with increased risk of both neonatal and maternal injury.
Adult↗
One-blade rotation of a persistent posterior vertex.
Fifteen women in labor at term with no evidence of protraction or arrest disorder successfully underwent a single-blade rotation of the fetus from occipitoposterior to occipitoanterior position. There were no failures, no fetal injuries, and no significant maternal trauma. This method of forceps rotation appears to be a safe alternative to current methods of managing occipitoposterior positions.
Female↗
[Improved Bamberg divergence forceps. Modification for the prevention of soft tissue injuries of the pelvis].
Constant and limited (max. 300 g) force of application by the Bamberg divergent forceps helps to prevent compression injuries and slippage of the forceps with resultant trauma. No serious foetal lesions have been observed over a period of 9 years. Maternal soft-tissue injuries were somewhat above the range of vacuum extractions. This prompted us to consider modifying the Bamberg forceps with a view towards preventing such maternal injuries.
Birth Injuries↗
Rotational forceps in midforceps delivery.
A series of consecutive midforceps rotations performed using purely rotational forceps is anslyzed. Leff forceps were designed to make forceps application less difficult and rotation less traumatic to mother and fetus. In many cases, rotation was done under local anesthesia and delivery was completely by traction with Simpson or outlet forceps. Cesarean section was done in 4 cases in which easy rotation and delivery were not possible.
Birth Injuries↗
Follow up of babies delivered in a randomized controlled comparison of vacuum extraction and forceps delivery.
Babies delivered in a randomized controlled comparison of vacuum extraction vs. forceps delivery were reassessed at 9 months of age. There were no statistically significant differences between the two groups as regards head circumference, weight, or head circumference to weight ratio, nor in the results of hearing and vision tests. The reasons for hospital readmission, pediatric follow-up and parents' and health visitors' worries appeared to be unrelated to the mode of delivery in nearly all cases. The finding in the original trial that neonatal jaundice was more common following vacuum extraction was reinforced by an additional case of jaundice in the vacuum extractor group which had necessitated readmission to hospital.
Child Development↗
Risk factors in childbirth causing damage to the pelvic floor innervation.
The innervation of the pelvic floor musculature is damaged in both stress urinary incontinence and idiopathic (neurogenic) anorectal incontinence. Because childbirth has been considered to be a causative factor in stress incontinence we have assessed the effect of childbirth on the innervation of the pelvic floor musculature in 122 consecutively referred women. They were investigated 48-72 h and 2 months after delivery; 51 were also studied 6 months prior to delivery. In 45 of these 51 women delivered vaginally, EMG studies of the external anal sphincter muscle showed that the fibre density (FD) increased from 1.38 +/- 0.14 before delivery to 1.57 +/- 0.19 2 months after delivery (p less than 0.01). There was no change in the FD in the external anal sphincter muscle after delivery in 20 women delivered by Caesarean section. The pudendal nerve terminal motor latency (PNTML) measured 48-72 h after delivery was increased in the 102 women delivered vaginally compared to 34 nulliparous control subjects. Analysis of the whole group of 122 women showed that multiparity, forceps delivery, increased duration of the second stage of labour, third degree perineal tear and high birth weight were important factors leading to pudendal nerve damage. Epidural anaesthesia had no effect on pudendal nerve function. Modification of these obstetric risk factors may ultimately reduce the frequency of stress urinary and faecal incontinence in women.
Adolescent↗
[Late clinical and electroencephalographic aspects of children delivered with forceps].
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Adolescent↗
Antibiotic prophylaxis for operative vaginal delivery.
BACKGROUND: Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics are prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. OBJECTIVES: To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum and/or forceps deliveries. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003) and MEDLINE (1966 to November 2003). SELECTION CRITERIA: All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS: Four reviewers assessed trial eligibility and methodological quality. Two reviewers extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all reviewers. We assessed methodological quality of the included trial using the standard Cochrane criteria and the CONSORT statement of randomised controlled trials. We calculated the relative risks using a fixed effect model and all the reviewers interpreted and discussed the results. MAIN RESULTS: One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the relative risk reduction was 93% (relative risks 0.07; 95% confidence interval (CI) 0.00 to 1.21). There was no difference in the length of hospital stay between the two groups (weighted mean difference 0.09 days; 95% CI -0.23 to 0.41). REVIEWERS' CONCLUSIONS: The data were too few and of insufficient quality to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
Antibiotic Prophylaxis↗
Wrigley forceps to deliver a bulky uterus following a total laparoscopic hysterectomy for endometrial cancer.
Morcellation of the uterus is contraindicated in endometrial cancer and a uterine size of 11 weeks or larger has been considered a contraindication for total laparoscopic hysterectomy (TLH) in endometrial cancer. We describe a new technique of removing a bulky uterus in a patient with endometrial cancer with the use of Wrigley forceps following a total laparoscopic hysterectomy.
Adenocarcinoma↗
[Peridural analgesia in labor. Comparison between bupivacaine and 2-chloroprocaine].
The purpose of this study was the comparison of the effects on the labor and neonates of epidural analgesia conducted either with bupivacaine or 2-chloroprocaine. Hundred and three parturients were included in the study. They were randomly divided in two groups. Sixty-three patients received bupivacaine in 0.25% solution and 40 received 2-chloroprocaine in 2% solution. Epinephrine was not added to local anesthetics. The first dose was 25 mg of bupivacaine (10 ml) or 200 mg of 2-chloroprocaine (10 ml). Reinjections occurred every 30 min for 2-chloroprocaine (80 mg) and every hour for bupivacaine (10 mg). The time of onset of cutaneous analgesia was similar in both bupivacaine (12.5 +/- 4.7 min) and 2-chloroprocaine (13.8 +/- 5.1 min) patients. The incidence of incomplete or insufficient analgesia was significantly higher with 2-chloroprocaine. The number of parturients who required forceps for conclusion of childbirth was not statistically different with bupivacaine (n = 25, 40%) or 2-chloroprocaine (n = 11, 28%) (CHI2 = 1.5971, p = 0.2063). The second stage of labour was significantly longer in parturients who required forceps extraction in both groups. These patients also received significantly more local anesthetics. All newborns had an Apgar score performed before the third minute following birth. All observed Apgar scores except one of bupivacaine group were over eight. Umbilical cord blood was drawn for pH determination. Cord blood pH was slightly but significantly lower in bupivacaine (7.314 +/- 0.106) than in 2-chloroprocaine (7.345 +/- 0.06) patients (t = 1.6968, p = 0.046). Newborns extracted with forceps after maternal bupivacaine epidural analgesia had a significantly lower umbilical blood pH (7.278 +/- 0.117) than newborns who did not required forceps in the bupivacaine group (7.337 +/- 0.093) (t = 2.1986, p = 0.0159).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[More on the Kielland forceps].
A study of 103 deliveries with Kielland forceps has been presented. Mother's age, parity, presentation, height of the head, anaesthesia, weight of the child, failures, puerperium, indications, injuries to the mother, conditions of the child, maternal and children mortality are discussed. Kielland instrument still maintains its position as a usefull specialized forceps for deep transverse arrest and also for obliqually placed fetal head.
Birth Injuries↗
Trends in the rate of shoulder dystocia over two decades.
OBJECTIVE: To describe the trend in the rate of shoulder dystocia over twenty-four years and identify the risk factors related to the occurrence of dystocia. METHODS: Data was obtained from Maryland State regarding all vaginal deliveries that occurred during six different time periods at five-year intervals since 1979. Trends in the rate of shoulder dystocia, episiotomy, forceps and vacuum delivery were examined. RESULTS: There were a total of 277 974 vaginal deliveries. The overall rate of shoulder dystocia was 1.29% (n = 3590). Induction of labor (adjusted OR 1.2, 1.1-1.3), presence of diabetes (gestational (OR 1.9, 1.7-2.3) or pre-gestational (OR 3.8, 2.7-5.4)), fetal macrosomia (OR 5.1, 4.1-6.3) use of episiotomy (OR 1.6, 1.5-1.8), forceps (OR 1.3, 1.0-1.8) or vacuum (OR 2.3, 2.0-3.9) at delivery were associated with a higher rate of shoulder dystocia. TREND: There was an increase in the rate of shoulder dystocia from 0.2% in 1979 to 2.11% in 2003. In addition there was a drop in the overall episiotomy rate from 73.67% to 23.94% and increase in the use of vacuum from 0.1% to 8.36%. CONCLUSION: The rate of shoulder dystocia has increased by 10 fold during the study period. The use of episiotomy either at spontaneous delivery or instrumental delivery does not appear to decrease the occurrence of shoulder dystocia.
Adolescent↗
[Comparison of blood loss during cesarean section and during vaginal delivery with episiotomy].
OBJECTIVE: The aim of our study was to compare blood loss during vaginal delivery with episiotomy and during cesarean section, to determine risk factors, and to determine whether clinical assessment of blood loss at delivery is well-evaluated. PATIENTS AND METHODS: We retrospectively matched 97 vaginal deliveries with episiotomy with 97 cesarean deliveries which has occurred between 1 November 1991 and 30 April 1993. Matching criteria were age, parity, term and birth weight. Blood loss at delivery was defined by a drop in hematocrit greater than 10% between the pre-delivery anesthesia work-up and the laboratory results 3 days post-partum. RESULTS: We found that hemoglobin and hematocrit fell more after vaginal deliveries than after cesarean section (p < 0.05 and p < 0.01). The fall in hemoglobin level and hematocrit were significantly greater after forceps delivery with episiotomy than after spontaneous vaginal delivery (p < 0.01 and p < 0.01). Among the vaginal deliveries, 11 showed laboratory criteria corresponding to blood loss at delivery despite clinical diagnosis in only 2 of them. Unwarranted clinical diagnosis of blood loss at delivery was however made 11 times after vaginal delivery and 19 times after cesarean (20%). CONCLUSION: Our findings demonstrate that blood loss during vaginal delivery with episiotomy is greater than during cesarean section and affirms the determining role of forceps use in association with episiotomy in this blood loss. Clinical assessment of blood loss at delivery lacks precision.
Adult↗
[Urinary disorders during pregnancy and post-partum].
In a study of 265 patients questioned in immediate post-partum, the authors observed a urinary incontinence during pregnancy in 46.4% of the cases and a post-partum incontinence in 21.5% of the cases. These figures are comparable to those found in literature. In this study, in agreement with the authors, the post-partum incontinence does not increase significantly when forceps have been used. On the other hand, it is exceptional after caesarian section. The incontinence observed during pregnancy and/or post-partum most often regresses in 60 to 80% of the cases. However, one can ask the question on whether it is not reveal a light pelvic alteration which could cumulate at each delivery. The difficulty to retain winds is observed in 26.7% of the cases. It seems to be correlated in a significant way to the use of forceps. The local--regional anaesthesia does not modify significantly the occurrence of urinary or rectal disorders.
Cesarean Section↗
A curriculum in practical clinical skills for family medicine residents.
The teaching of practical clinical skills to medical students and residents has been traditionally taught on an unstructured basis. This has led to situations in which physicians have been expected to perform manual procedures without adequate prior exposure or instruction. As a result of this perceived deficit in training, a curriculum has been designed to prepare new family medicine residents for some of the procedures they will be expected to perform in their first year of training. These procedures include airway management and endotracheal intubation, orthopedic casting, use of outlet forceps, suturing, and cardiopulmonary resuscitation.
Airway Obstruction↗
Fetal risk in delivery with the Shute parallel forceps: analysis of 1,503 forceps deliveries.
A total of 1,503 vaginal deliveries with the Shute parallel forceps during a 10 year period are analyzed as to the risk of instrumental damage. In this series, 35 infants died intrapartum or neonatally. Eliminating all deaths from unrelated causes, three remain in which the forceps could possibly have been implicated. Investigation of these, however, revealed in each case the presence of other concomitant and potentially lethal factors, none of which could be completely ruled out as the primary cause of fetal death. Each of the three cases is discussed in detail. We conclude from our series that the Shute forceps is useful in the delivery of premature infants, but should be employed for this maneuver only by very experienced operators. In these cases, midforceps should be performed only for critical indications. The risk of damage with parallel forceps deliveries from the pelvic floor is minimal if decision for operation is based on cardiotocographic criteria, and under favorable degrees of oxygenation. In the delivery of the immature infants, the parallel forceps can, in fact, hardly be superseded by any other instrument because of its unique controlled protection of the fragile fetal head from even the pressures of the birth canal. Delivery with the Shute forceps can be performed effectively under pudendal block or local infiltration anesthesia.
Adult↗