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At least 757 records · Page 42Linked to original sources
PubMed1993

The effect of forceps delivery on cognitive development.

OBJECTIVE: We evaluated the influence of forceps delivery on cognitive development of preschool children. STUDY DESIGN: A cohort of 3413 children who were born at the Kaiser Permanente Medical Center in Oakland, California, were selected at age 5 for intelligence quotient testing with the Peabody Picture Vocabulary Test and the Raven Coloured Progressive Matrices. Data were analyzed by means of the Student t test to compare mean intelligence quotient scores of intervention modes of delivery with spontaneous delivery. RESULTS: No significant difference in intelligence quotient was seen in 1192 children delivered by forceps (114 midforceps) compared with 1499 who were delivered spontaneously. CONCLUSION: The association of forceps delivery with adverse cognitive development cannot be supported.

Child Development↗
PubMed2000

Rectal prolapse during pregnancy. A case report.

BACKGROUND: Rectal prolapse is a bothersome surgical problem that is relatively infrequent. It usually occurs in the fifth to seventh decades of life and is more common in women. CASE: A 33-year-old woman, gravida 3, para 2, was found to have a large rectal prolapse at 33 weeks' gestation. Manual reduction was successfully performed after injecting 2% lidocaine into and around the anal sphincter. Because she could not undergo definitive surgical repair during her pregnancy, the patient was managed with an aggressive stool softening regimen and self-reduction techniques. Labor was induced in the 40th gestational week. Epidural anesthesia was employed, and delivery was accomplished via low-outlet forceps application. The patient underwent definitive surgical repair of the rectal prolapse eight weeks postpartum. CONCLUSION: Rectal prolapse is a rare condition during the childbearing years. We found no prior case reports of rectal prolapse occurring during pregnancy. While childbirth itself is not considered a risk factor for rectal prolapse, a prior history of perineal lacerations may be a risk factor. To manage rectal prolapse that occurs during pregnancy, consideration should be given to passive forceps delivery under epidural anesthesia to avoid the possibility of worsening the prolapse.

Adult↗
PubMed1987

Paresthesias and motor dysfunction after labor and delivery.

The incidence of paresthesias and motor dysfunction associated with 23,827 deliveries at Winnipeg Women's Hospital during a 9-yr period (1975-1983) was 18.9/10,000 deliveries. All the symptoms resolved within 72 hr after supportive therapy only. The frequency of paresthesias and motor dysfunction was greater in primiparas, women who had forceps- or vacuum-assisted deliveries, and women who had epidural or general anesthesia. Significant neurologic deficits after labor and delivery with or without epidural anesthesia were rare. Epidural anesthesia is a safe technique in this regard.

Anesthesia, Epidural↗
PubMed1989

Efficacy of prophylactic antibiotics for the prevention of endomyometritis after forceps delivery.

The purpose of this prospective randomized controlled clinical trial was to determine whether prophylactic antibiotics reduce the incidence of endomyometritis after forceps delivery. Of the 393 patients studied, 192 received 2 gm of intravenous cefotetan after forceps delivery, and 201 patients received no antibiotics. There were seven cases of endomyometritis in the group given no antibiotic and none in the cefotetan group, a statistically significant difference (P less than .01). We conclude that prophylactic antibiotics are effective in reducing the incidence of endomyometritis after forceps delivery. We believe this is the first published study demonstrating this benefit.

Adult↗
PubMed2005

Laparoscopic anterior resection and uterine manipulation: why make things difficult?

The uterus continues to be a source of difficulty in mobilization of the rectum. These difficulties are compounded in laparoscopic operations, particularly anterior resection, proctectomy and vaginal sacrocolpopexy. Techniques to overcome this have in general proved unsatisfactory. We have adopted a technique of using an extended Vesellum forceps from gynaecological practice and recommend its use by all. The technique is described.

Colon↗
PubMed1994

A study of the effect of rotational forceps delivery on fetal acid-base balance.

OBJECTIVE: To determine whether Kiellands forceps rotational delivery causes a significant reduction in fetal pH or base excess, as compared to a control group delivered using non-rotational forceps. DESIGN: A prospective observational study. SETTING: A teaching hospital labor ward in the UK. METHODS: Fetal blood sampling was performed prior to delivery by Kiellands forceps (n = 26) or by non-rotational forceps (n = 24). Following delivery, the umbilical vein was sampled. OUTCOME MEASURES: The changes in fetal pH and base excess. RESULTS: No significant changes in pH were noted in fetuses delivered using Kiellands forceps or in those delivered using Neville Barnes forceps. However, whilst no changes in base-excess were found in the fetuses delivered using Neville Barnes forceps, there were significant changes in base-excess in those fetuses delivered using Kiellands forceps. CONCLUSION: This small study suggests that delivery by Kiellands forceps may result in a significant deterioration in fetal acid-base balance.

Acid-Base Equilibrium↗
PubMed1990

Neonatal and maternal outcome in low-pelvic and midpelvic operative deliveries.

A retrospective analysis of low-pelvic and midpelvic operative deliveries (according to the new definitions by the American College of Obstetricians and Gynecologists, 1989) matched with cesarean section deliveries of similar station was undertaken. In all vaginally delivered groups there was significantly decreased maternal morbidity, maternal hospital stay, and estimated blood loss. In the midpelvic deliveries, there was a significant increase in the frequency of neonatal resuscitation and an increase in base deficit for the umbilical artery. In both the midforceps and low-forceps groups, there was a significant increase of neonates with cord arterial pH less than 7.10, and an increase of base deficit, even when cases of fetal distress were eliminated. The midforceps group also had an increased rate of admission to the intensive care nursery and an increase in the risk of significant birth trauma. In considering a midforceps or midvacuum operative delivery, the potential associated risks to the neonate must be balanced against the benefits to the mother.

Birth Injuries↗
PubMed1999

Is the vacuum extractor really the instrument of first choice?

This study was a retrospective analysis of the pattern of usage of both the forceps and vacuum extractor as well as the neonatal outcome on all the instrumental deliveries conducted in 1995 at the Kandang Kerbau Hospital, Singapore. There were a total of 927 forceps deliveries and 495 vacuum extractions but neonatal data was available for only 481 forceps and 255 vacuum extractor babies. (There were 2 neonatal units which accepted admissions on alternate days; all of the data were collected from 1 of the units only). Demographic data were comparable in most aspects except that vacuum deliveries were significantly associated with higher parity and shorter labours. There was a trend towards using the vacuum extractor in less difficult cases. Almost all the instrumental deliveries were conducted by specialists. Birth trauma was significantly more likely to occur with the vacuum extractor. Almost all the deliveries were conducted with similar expertise in both groups, yet the use of the vacuum extractor resulted in more birth trauma even in the presence of 'easier' cases. This may suggest an inherent risk in using the vacuum extractor.

Adult↗
PubMed2005

Forceps compared with vacuum: rates of neonatal and maternal morbidity.

OBJECTIVE: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations. METHODS: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution. Outcomes examined included rates of neonatal trauma, shoulder dystocia, and perineal lacerations. Potential confounders, including maternal age, birthweight, ethnicity, parity, station at delivery, episiotomy, attending physician, anesthesia, and length of labor, were controlled for using multivariate logistic regression. RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%) vacuum-assisted deliveries, the rate of shoulder dystocia was lower among women undergoing forceps delivery (1.5% compared with 3.5%, P < .001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P < .001), whereas the rate of third- or fourth-degree perineal laceration was higher (36.9% compared with 26.8%, P < .001). These differences in perinatal complications persisted when controlling for the confounders listed above. The adjusted odds ratio for shoulder dystocia was 0.34 (95% confidence interval [CI] 0.20-0.57), for cephalohematoma was 0.25 (95% CI 0.19-0.33), and for third- or fourth-degree lacerations was 1.79 (95% CI 1.52-2.10) when comparing forceps to vacuum. CONCLUSION: Vacuum-assisted vaginal birth is more often associated with shoulder dystocia and cephalohematoma. Forceps delivery is more often associated with third- and fourth-degree perineal lacerations. These differences in complications rates should be considered among other factors when determining the optimal mode of delivery. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed1997

Neonatal intracerebellar hemorrhage after forceps delivery. Report of a case without neurologic damage.

BACKGROUND: Neonatal intracerebellar bleeds are very rare and often seen in association with forceps or vaginal breech deliveries. Frequently the neonate requires surgical evacuation of the hemorrhage. These neonates are most often left with significant neurologic sequelae. Medical management has been reported but with poor outcomes. CASE: A primigravida with a twin gestation delivered at 37 weeks. The delivery was facilitated by the use of low forceps for both infants. Twin B was diagnosed with a massive intracerebellar bleed on day 2 of life. She did not undergo surgical drainage due to an improvement in her clinical status. Follow-up examinations were completely normal, and the infant was developing normally at 2.5 years of age. CONCLUSION: Low forceps deliveries can be associated with massive neonatal cerebellar hemorrhage, and these bleeds can be managed successfully without surgical drainage.

Birth Injuries↗
PubMed2005

[Decision-to-deliver interval for forceps delivery and cesarean section: 137 extractions for abnormal fetal heart rhythm during labor].

AIM: Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. MATERIAL AND METHOD: A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. RESULTS: The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84 min +/- 6.54 versus 29.31 min +/- 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable. CONCLUSION: This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.

Adult↗
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↗
PubMed2002

Punch biopsy of the human placental bed.

OBJECTIVE: The purpose of this study was to report our experience with placental bed biopsy with the use of forceps. STUDY DESIGN: Placental bed biopsies were undertaken transcervically under ultrasound guidance in 313 women who underwent termination of pregnancy between 7 and 20 weeks of gestation, in 104 women with a missed abortion who underwent evacuation of retained products of conception between 7 and 21 weeks of gestation, and in 13 women after vaginal delivery. Placental bed biopsies were also undertaken in 139 women who underwent caesarean delivery. Frozen sections were immunostained with monoclonal antibodies to cytokeratin, factor VIII-related antigen, and desmin. RESULTS: Of the 417 cases attempted at <22 weeks, the placental bed was successfully sampled 281 women (67%); in 229 women (55%), at least one of the biopsy specimens contained a uterine spiral artery. Success was correlated with gestational age. Figures for the late cases that were sampled during caesarean delivery were 108 of 139 cases (78%) and 66 of 139 cases (47%) and after vaginal delivery were 11 of 13 cases (84%) and 6 of 13 cases (46%), respectively. The sampling procedure did not result in any significant morbidity. CONCLUSION: With the use of forceps, uterine spiral arteries can be sampled successfully throughout pregnancy in approximately 50 % of cases.

Arteries↗