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PubMed1977

The relation between umbilical cord tissue prostaglandin E2 levels, mode of onset of labour, fetal distress and method of delivery.

The tissue concentrations of prostaglandin E2 (PGE2) were measured by radioimmunoassay in components of the umbilical cord. The levels were significantly higher in the walls of arteries than in non-vascular tissue from the umbilical cord. The highest values were found after emergency Caesarean sections and the lowest after induced ending in normal delivery. The use of forceps and the presence of fetal distress were both associated with significantly raised tissue concentrations of PGE2.

Cesarean Section↗

PubMed1983

Should we abandon Kielland's forceps?

To assess the risks associated with the use of Kielland's forceps 2708 consecutive deliveries were studied prospectively and the neonatal outcome related to the mode of delivery. Of the 1191 primigravidas, 279 (23.4%) underwent instrumental delivery, of whom 65 (5.5%) were delivered with Kielland's forceps. There was no difference in early neonatal outcome (as judged by Apgar scores, intubations, and admission to the special care baby unit) between these babies and those delivered normally or by non-rotational forceps, but a higher proportion of the 127 (10.7%) delivered by emergency caesarean section were compromised. Of the 1517 multigravid patients, only 57 (3.8%) underwent instrumental delivery, 15 (1.0%) by Kielland's forceps. Among these babies, also, the outcome was no worse than for those delivered normally, but the babies delivered by caesarean section showed a greatly increased incidence of low Apgar scores, intubations, and admission to the special care baby unit. There were no stillbirths or neonatal deaths among babies delivered by Kielland's forceps, nor were there any cases of severe birth trauma or of obvious neonatal morbidity.

Apgar Score↗

PubMed1999

Sequential use of instruments at operative vaginal delivery: is it safe?

OBJECTIVE: Our purpose was to examine maternal and neonatal outcomes in a cohort of women who underwent delivery with the sequential use of instruments. STUDY DESIGN: This retrospective case-control study included deliveries from May 1996 through March 1998. Charts of women who underwent delivery with the sequential use of instruments (vacuum first, then forceps, or vice versa) were identified. Two control groups (1 forceps group, 1 vacuum group) were randomly selected and matched for each case. Maternal and neonatal outcomes were abstracted and compared. RESULTS: There were 34 patients in each group. There were no significant demographic differences. The vacuum group had lower rates of episiotomy (P =.01) and deep perineal lacerations (P =.014), whereas these outcomes were similar in the sequential and forceps groups. All other maternal outcomes were equivalent. There were no differences in any neonatal parameter except for superficial scalp trauma, which was more common in the vacuum group (P =.002). CONCLUSION: We conclude that the prudent use of sequential instruments at operative vaginal delivery did not engender higher rates of maternal or neonatal morbidity.

Adult↗

PubMed1993

Anal-sphincter disruption during vaginal delivery.

BACKGROUND: Lacerations of the anal sphincter or injury to sphincter innervation during childbirth are major causes of fecal incontinence, but the incidence and importance of occult sphincter damage during routine vaginal delivery are unknown. We sought to determine the incidence of damage to the anal sphincter and the relation of injury to symptoms, anorectal physiologic function, and the mode of delivery. METHODS: We studied 202 consecutive women six weeks before delivery, 150 of them six weeks after delivery, and 32 with abnormal findings six months after delivery. Symptoms of anal incontinence and fecal urgency were assessed, and anal endosonography, manometry, perineometry, and measurement of the terminal motor latency of the pudendal nerves were performed. RESULTS: Ten of the 79 primiparous women (13 percent) and 11 of the 48 multiparous women (23 percent) who delivered vaginally had anal incontinence or fecal urgency when studied six weeks after delivery. Twenty-eight of the 79 primiparous women (35 percent) had a sphincter defect on endosonography at six weeks; the defect persisted in all 22 women studied at six months. Of the 48 multiparous women, 19 (40 percent) had a sphincter defect before delivery and 21 (44 percent) afterward. None of the 23 women who underwent cesarean section had a new sphincter defect after delivery. Eight of the 10 women who underwent forceps delivery had sphincter defects, but none of the 5 women who underwent vacuum extractions had such defects. Internal-sphincter defects were associated with a significantly lower mean (+/- SD) resting anal pressure (61 +/- 11 vs. 48 +/- 10 mm Hg, P < 0.001) six weeks post partum, and external-sphincter defects were associated with a significantly lower squeeze pressure (increase above resting pressure, 70 +/- 38 vs. 44 +/- 13 mm Hg; P < 0.001). There was a strong association (P < 0.001) between sphincter defects and the development of bowel symptoms. CONCLUSIONS: Occult sphincter defects are common after vaginal delivery, especially forceps delivery, and are often associated with disturbance of bowel function.

Adolescent↗

PubMed1975

[Traumatic injury of a permanent tooth by forceps delivery (presentation of a case)].

A case of malformation of an upper central permanent incisor is described. From the history, it is assumed that the isolated malformation of the affected tooth, No. 21, may be due to indirect consequences of a birth trauma (forceps delivery). The problems of developing malformations connected with this case are discussed generally and specifically for a single tooth.

Birth Injuries↗

PubMed1983

Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps.

In a population of 1065 singleton, low birth weight infants (1000 to 2500 g) delivered vaginally from vertex presentation, the neonatal mortality and morbidity of 394 delivered by low forceps were compared with those of 671 delivered spontaneously. There were no significant differences between the groups, either across the population as a whole or among any of the following birth weight subgroups: 1000 to 1500 g, 1501 to 2000 g, and 2001 to 2500 g. The data in the current study, as well as those from previous reports, argue against the routine use of prophylactic low forceps delivery and in favor of a more individualized approach to the vaginal delivery of infants in vertex presentation in this weight group.

Birth Weight↗

PubMed2000

Instrumental delivery of the fetal head at the time of elective repeat cesarean: a randomized pilot study.

We sought to ascertain whether the routine use of instruments, forceps or vacuum, at the time of elective repeat cesarean delivery, permits a delivery that is as safe for mother and infant and as easy for mother and physician as traditional manual delivery of the fetal head. In this prospective study 44 women undergoing elective repeat cesarean were randomized to deliver by Vacuum (V), Forceps (F), or by Manual (M) means. Groups were compared with regard to demographic variables and maternal and neonatal outcomes. Deliveries were timed from entry into the uterus until full delivery of the infant. Maternal pain scores were assessed using a 10-cm visual analog scale. There were no differences in demographic variables except that the M group had fewer women with up to two cesareans. A large percentage of women in each group were delivered with the randomized instrument. Use of the V did not demonstrate fewer extensions of the uterine incision or lesser amounts of blood loss as measured by serial hemoglobin determinations. There was a trend for the F group to require a longer period of time for delivery (p = 0.061). Women in the V group reported significantly lower pain scores (p = 0.015). There were no serious neonatal injuries. The routine use of instruments at the time of elective repeat cesarean delivery appears safe and effective.

Adult↗

PubMed1995

Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American College of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies.

OBJECTIVE: Our purpose was to investigate the maternal and neonatal effects of elective low-forceps delivery, as currently defined by the 1988 criteria of The American College of Obstetricians and Gynecologists. STUDY DESIGN: During a 6-month period we conducted a prospective study that included 50 nulliparous term parturients who were randomly allocated to spontaneous or elective low-forceps delivery. Patients with either maternal or fetal disorders that could affect the outcome were excluded. All deliveries were attended by three experienced obstetricians. RESULTS: Spontaneous and forceps delivery group were similar regarding maternal or gestational age, fetal scalp pH, antepartum maternal hemoglobin and hematocrit levels, maternal outcome, mean birth weight, and number of neonates with low Apgar scores or cord arterial pH < 7.20. In the spontaneous delivery group the time elapsed since randomization to delivery was significantly longer (18 vs 10.2 minutes, p < 0.001) and the mean cord arterial pH was significantly lower (7.23 vs 7.27, p = 0.01) than in the forceps delivery group. CONCLUSION: Elective low forceps delivery may be used to shorten the second stage of labor without immediate maternal or neonatal side effects.

Adult↗

PubMed2004

Cohort study of forceps delivery and the risk of epilepsy in adulthood.

OBJECTIVE: The purpose of this study was to investigate the relationship between forceps delivery and epilepsy in adulthood. Study design We conducted a cohort study of 21,441 births with record linkage to data from the Tayside Medicine Monitoring unit (MEMO) and Scottish morbidity records (SMR1). RESULTS: Delivery by forceps was not associated with epilepsy compared with all other deliveries, adjusted odds ratio (OR) 1.0 (95 % CI, 0.6-1.8). Epilepsy in adulthood was associated with a family history of epilepsy, adjusted OR 2.4 (95% CI, 1.7-3.2), increasing social deprivation, adjusted OR 1.1 for each Carstairs score (95% CI, 1.0-1.2), and male gender, adjusted OR 1.4 (95% CI, 1.0-1.8). Preterm birth was associated with an increased risk of epilepsy, adjusted OR 2.0 (95% CI, 1.2-3.2) but no other antenatal, intrapartum, or neonatal risk factors were identified. CONCLUSION: These findings do not suggest an association between forceps delivery and epilepsy in adulthood; however, preterm birth may be an important risk factor.

Adult↗

PubMed1982

Rotational delivery of the fetus: Kielland's forceps and two other methods compared.

A retrospective comparison was undertaken of 552 cases in which Kielland's forceps were used for rotation and delivery, 95 cases in which other forceps were used for rotation and delivery, and 160 cases in which manual rotation and forceps were used. There was no significant difference in maternal or fetal morbidity between the three groups, regardless of whether the indication for delivery was delay in the second stage of labour or fetal distress. When Kielland's forceps were used by junior staff, significantly more vaginal and cervical lacerations and primary postpartum haemorrhage occurred, but there was no increase in fetal morbidity.

Extraction, Obstetrical↗

PubMed2003

[Delivery by forceps: indications and materno-fetal morbidity].

A retrospective study concerning patients having had a delivery by means pair of forceps over a period going from 1st Jun 1999 to 31st December 2000. The frequency of the use of forceps for delivery is 4.95%. The defect of eviction was an indication of the pair of forceps. Fetal suffering was the main indication. Maternal morbidity was represented essentially by a more or less injury of the genital tract with a rate of 11.1%. The rate of neonatal mortality is 1.28%. The maternal improvement of the maternal and fetal prognosis depends on an accurate indication of the use of forceps. In certain circumstances, mainly in fetal suffering, it is often difficult to choose between the high way and the low way.

Extraction, Obstetrical↗

PubMed1992

Kielland's forceps delivery: is it a dying art?

A retrospective study in the use of Kielland's Forceps for rotation of the foetal head and mid-cavity delivery in Kandang Kerbau Hospital, Singapore from 1987-1990 is presented. Out of a total of 53,889 singleton births during this period, Kielland's Forceps was used for delivery in 137 (0.25%) patients with an incidence of 0.65% in the primiparae and 0.07% in the multiparae. Primiparity, induction of labour and epidural analgesia were associated with a significantly higher incidence of rotational delivery by Kielland's forceps. The success rate of Kielland's forceps delivery was 93.4% (128 of 137). There was no maternal or perinatal mortality. About one-third of the mothers experienced postpartum morbidity, commonest being retention of urine, postpartum haemorrhage and vaginal lacerations. Traumatic injuries were present in about one-quarter of the babies and were minor. Out of a total of 306 mid-cavity deliveries for occipito-transverse malposition, Kielland's forceps accounted for 38.2% (117), vacuum extraction 30.7% (94), manual rotation followed by Neville-Barnes forceps 11.1% (34) and Caesarean section 20.0% (61). The junior specialists tended to use vacuum extraction for rotational delivery more than the senior specialists.

Birth Injuries↗

PubMed2002

Factors associated with success or failure in trials of vacuum extraction.

Failure rates for vacuum extraction of between one in 16 and one in 600 have been reported. Most studies report that unexpected failure carries a greater risk to both mother and fetus. The aim of this study was to determine factors that were likely to predict success or failure in trials of vacuum extraction. At the Port Moresby General Hospital, 59 trials of vacuum extraction were performed between 1 December 1997 and 30 November 1999. These cases were analysed according to whether vacuum extraction was achieved with more than or less than three pulls, or an alternative method of delivery was required to effect delivery Factors that were predictive of failure were: (i) Highlands origin of the mother; (ii) longer duration of the second stage of labour; (iii) severe moulding of the fetal head; (iv) cup detachments and deflexing cup applications; and (v) operator persisting with the procedure after three pulls. The cervix being less than fully dilated when the trial was commenced was not associated with a higher risk of failure, nor was it associated with a significantly higher risk of cervical trauma. Perinatal death and serious fetal scalp trauma were associated with deflexing cup applications, making more than three pulls and failed vacuum extractions.

Adult↗

PubMed2006

Maternal morbidity and mortality associated with delivery after intrauterine fetal death.

OBJECTIVE: To determine the maternal morbidity and mortality associated with delivery after intrauterine fetal death (IUFD) and to find out the place of fetal destructive procedures and cesarean section. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Labour Room, Nishtar Hospital, Multan from January to December 2003. PATIENTS AND METHODS: All women were included in the present study who presented before the onset of labour pains, after intrauterine fetal death at 26 weeks or onward with singleton pregnancy. Assessment of maternal demographic characteristics, gestational age at fetal demise, delivery-IUFD interval, mode of delivery; vaginal with or without fetal destructive procedures/cesarean section and maternal complications were the main outcome measures. RESULTS: There were 1834 live birth and 63 deliveries with intrauterine fetal death. Mode of delivery was vaginal in 87.4% and cesarean section in 12.6% of the cases. Twelve (21%) of the vaginal deliveries were complicated by lower urogenital tract injuries in certain cases, whereas 75% (6/8) of patients delivered by cesarean section developed major postoperative complications like postpartum haemorrhage, shock, endometritis, peritonitis and wound dehiscence. No maternal death was identified. Rate of delivery with intrauterine fetal death was 34.3/1000 live-birth deliveries. CONCLUSION: Maternal morbidity like perineal tear, urinary tract infection, menstrual disorder and even secondary infertility may follow after vaginal mode of delivery by forceps and destructive procedures. The frequency and severity of complications after cesarean delivery are quite higher and may rarely lead to even maternal death.

Cesarean Section↗

PubMed1984

Retinal hemorrhages in the preterm neonate. A prospective randomized study comparing the occurrence of hemorrhages after spontaneous versus forceps delivery.

The incidence and magnitude of retinal hemorrhages (RH) in a group of 23 preterm infants (29-35 weeks) born spontaneously in vertex presentation have been compared with those of 23 others (28-35 weeks) born by gentle extraction with small forceps. Distribution to the groups was random. The overall frequency of RH in both groups together was low, 6%, with no statistically significant difference between the groups. No fundi with severe (grade III) hemorrhages were seen. Both the incidence and magnitude of RH were less in the preterm neonates when compared with previously reported figures in term infants born spontaneously or with forceps extraction. The study provides further evidence in support of the hypothesis that fetal head compression with venous congestion is the main cause of RH in the newborn.

Delivery, Obstetric↗

PubMed1991

Maternal and neonatal effects of outlet forceps delivery compared with spontaneous vaginal delivery in term pregnancies.

Previous retrospective studies have suggested that the prophylactic use of outlet forceps has a beneficial impact on the neonate because it shortens the second stage of labor and decreases the incidence of neonatal hypoxia. The purpose of this study was to compare the immediate maternal and neonatal effects of outlet forceps delivery (N = 165) with spontaneous vaginal delivery (N = 168) in term parturients. Subjects were randomized to the study or control group immediately before delivery. There were 88 nulliparas and 77 multiparas in the forceps delivery group and 90 and 78, respectively, who delivered spontaneously, a nonsignificant difference. There were no significant differences in gestational age, parity, infant birth weight, length of the first and second stages of labor, use of conduction (continuous epidural) anesthesia, decrease in hematocrit values, Apgar scores, or umbilical arterial pH values between the forceps and spontaneous delivery groups. Seventeen infants in the forceps group and 16 in the control group had cephalhematoma, facial bruising, subconjunctival hemorrhage, or scalp abrasion (not significant). No neonate had fractures, nerve palsies, or intracranial hemorrhage (determined by cranial ultrasound). In the nulliparous population, significant differences were found in the use of episiotomy (93 versus 78%) and the incidence of deep perineal lacerations (24 versus 10%) with forceps compared with spontaneous delivery, respectively (P less than .05). No significant differences between the groups were found in multiparas. We conclude that the use of outlet forceps in patients with uncomplicated labor has no immediate effect on the neonate. Furthermore, outlet forceps delivery does not significantly shorten the second stage of labor and is associated with an increased incidence of maternal perineal trauma.

Delivery, Obstetric↗

PubMed1985

[Effects of various anesthesia procedures used in forceps delivery on the cardiopulmonary adaptation of the newborn infant. 1. Modification of cardiac adaptation].

Healthy, spontaneously born infants, delivered at the calculated time shows a postnatal tachycardia combined with harrowing of oscillation. But then there is a normalisation in heart action. This phenomenon is nearly the same both in spontaneous delivery and intubation anesthesia for forceps delivery starting with propanidid. Therefore propanidid is of less risk for the neonate. But after hexobarbital anesthesia our results reveal a lingering cardial adaption of the neonate, which is statistical significant. This points to possible cardiac depressive side effects of this drug. Therefore the usage of hexobarbital anesthesia should be well considered in obstetrics.

Anesthesia, Obstetrical↗

PubMed2000

Severe perineal lacerations during vaginal delivery: the University of Miami experience.

OBJECTIVE: After childbirth-related third- or fourth-degree perineal lacerations, the estimated incidence of wound disruption, fecal incontinence, or fistula ranges from 1% to 10%. Risk factors associated with severe laceration were analyzed at a single large teaching institution. STUDY DESIGN: This study consisted of an analysis of data from the delivery database of Jackson Memorial Hospital, University of Miami, from 1989 through 1995. Included were vaginal deliveries for which complete information was available on maternal age, parity, ethnicity (white, black, or Hispanic), birth weight, episiotomy versus no episiotomy, type of episiotomy, and delivery (normal spontaneous, vacuum, or forceps). Multiple gestations, cases of shoulder dystocia, cesarean deliveries, patients with a history of cesarean delivery, and babies weighing <500 g at birth were excluded from this study. Both univariate and multivariate analyses were performed with variables such as maternal age, race, birth weight, type of episiotomy if any, and type of vaginal delivery. RESULTS: Among the 71,959 women who were delivered at our institution during the 7-year study period, 50,210 met the inclusion criteria. Through time there had been a decline in the use of episiotomy in general and of midline episiotomy in particular. The annual total number of deliveries also decreased. The episiotomy procedure per se and the type of episiotomy as well as birth weight, assisted vaginal delivery, and older maternal age were identified as independent risk factors associated with third- and fourth-degree perineal lacerations. CONCLUSION: Although episiotomy is an important risk factor for severe lacerations after vaginal delivery, there are other significant independent risk factors, such as maternal age, birth weight, and assisted vaginal delivery, that should be considered in counseling and making decisions regarding delivery modality. Older patients who are being delivered of a first child are at higher risk for severe laceration. Midline episiotomy and assisted vaginal delivery should therefore be avoided in this population whenever possible, especially in the presence of a large baby.

Adult↗