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PubMed1987

Acid-base evaluation of umbilical cord blood: relation to delivery mode and Apgar scores.

Acid-base status of umbilical artery and vein blood was measured immediately after delivery in 300 cases. A slight acidosis of mixed respiratory/metabolic type was found in newborns delivered following a second stage of 10-30 min duration. After a second stage of more than 30 min the metabolic contribution to the acidosis was predominating. With Apgar scores lower than 10 the pH was found to decrease and carbon dioxide tension to increase. Induction or augmentation of labor by oxytocin did not influence the acid-base status of umbilical cord blood. Delivery by vacuum extraction or low forceps resulted in lower pH and higher carbon dioxide tension in umbilical cord blood, but the changes were associated with the indication for instrumental delivery and not with mode of delivery. A large arterio-venous difference between the acid-base parameters was usually connected to vigorous newborns and a small difference to depressed infants. The carbon dioxide tension was usually increased in newborns with decreased pH, and a close correlation between these parameter was found. No case of acidosis (pH below 7.15) was found in this population at carbon dioxide tensions below 7.2 kPa; at higher Pco2 values only 25% of the newborns were acidotic. A Pco2 level of 7.7 kPa might be used at transcutaneous carbon dioxide monitoring during labor, although the sensitivity and specificity of this parameter will have to be decided in a prospective study.

Acid-Base Equilibrium↗
PubMed1983

Oxytocin deficiency at delivery with epidural analgesia.

The effect of epidural analgesia on oxytocin release during the second stage of normal labour was studied by comparing 10 primigravidae who had epidurals with 10 control subjects who did not have epidurals. A significant increment in oxytocin between paired peripheral blood samples taken at the onset of full cervical dilatation and crowning of the fetal head was found in the control subjects but not in those with epidurals. Forceps delivery was required more often in the group with epidural analgesia and was associated with lower oxytocin levels at crowning. Since distension of the lower birth canal and stimulation of pelvic autonomic nerves leads to oxytocin release, and the need for forceps associated with epidurals can be reduced by oxytocin, these differences are attributed to the lumbar epidural block.

Adolescent↗
PubMed2001

Umbilical cortisol levels as an indicator of the fetal stress response to assisted vaginal delivery.

OBJECTIVES: While it is well established that delivery by elective caesarean section is less stressful for the fetus than normal vaginal delivery, little attention has been paid to the effect on the baby of an assisted delivery. STUDY DESIGN: We examined cortisol levels in venous cord blood from seven babies born by forceps, 10 by ventouse extraction, 28 by unassisted normal vaginal delivery, and 12 born by elective caesarean. Paired maternal bloods were taken immediately after delivery. RESULTS: Cord blood cortisol values were significantly different in the different groups (one-way ANOVA, P < 0.0001). The forceps group had the highest values and the caesarean group the lowest; both were different from the normal vaginal delivery group (P=0.019 and P=0.046, respectively). There was no effect of length of labour, or method of pain relief on cortisol levels. Maternal values were similar in the different groups, confirming that the differences observed derived from the fetus. CONCLUSIONS: There is increasing evidence that the stress experienced by the fetus or neonate can have long-term effects on the function of the hypothalamic-pituitary-adrenal axis in later life. We speculate that the stress caused by some assisted deliveries may contribute to this.

Cesarean Section↗
PubMed1995

Forcep deliveries.

A historical review of the development of forceps and the refinements made that lend them to different clinical situations are presented. The proper settings for their use and the choice of instruments and methods of application for traction and rotation are discussed. The risks to mother and infant are considered. Following these general precepts should allow for continued safe usage in modern day obstetrics.

Birth Injuries↗
PubMed2000

Choroidal rupture associated with forceps delivery.

PURPOSE: To report a case of choroidal rupture associated with forceps delivery. METHOD: Case report. RESULTS: We examined a 4-year-old boy with a history of a retinal scar in the right eye. The child was delivered with forceps and had bitemporal ecchymoses at birth. There was no other history of trauma. Ophthalmoscopic examination of the right eye with a vision of counting fingers revealed linear scars from choroidal rupture in the posterior pole, including one through the macula. Anterior segment examination was normal. Examination of the left eye was completely normal. CONCLUSION: Ocular trauma associated with forceps delivery may rarely result in choroidal ruptures, even in the absence of external signs of injury, such as breaks in Descemet membrane.

Child, Preschool↗
PubMed2001

Forceps delivery after molar malignancy in a woman with arteriovenous malformation. A case report.

BACKGROUND: An arteriovenous (AV) fistula in the female pelvis is a rare finding. This report describes a successful pregnancy after selective embolization of a postmolar vascular malformation. CASE: At 5 weeks of pregnancy, a 27-year-old, white female, gravida 3, para 0, was discovered on ultrasound examination to have an AV malformation along with a fetal pole. The patient was asymptomatic and had previously received two courses of chemotherapy for a previous nonmetastasized malignant molar pregnancy. Doppler ultrasonography uncovered a vascular malformation extending from the margin of the fetal pole to the margin of the uterus. The pregnancy ended at 8 weeks with a spontaneous abortion. The patient underwent angiography and embolization of extensive right-sided uterine vessels. She resumed normal menstrual periods six weeks after the embolization and became pregnant. The pregnancy concluded in low forceps vaginal delivery of a healthy, female infant at 34 weeks. CONCLUSION: Vaginal delivery following postmolar pregnancy and a uterine AV malformation may be considered a viable delivery option.

Adult↗
PubMed2003

[Instrumental extraction in 2002 in the "AURORE" hospital network: incidence and serious neonatal complications].

OBJECTIVES: The purpose of this study was to evaluate the incidence of forceps and vacuum application and the incidence of its related neonatal complications. This study was performed in a network of 37 maternity hospitals. PATIENTS AND METHOD: A postal questionnaire was sent to 156 obstetricians between February and March 2003. RESULTS: Response rate was 78%. In 2002 the operative vaginal delivery rate was 11.2% of all live births. Forceps are the primary instruments (6.3%) whereas vacuum delivery rate was 4.9%. One obstetrician never uses forceps while 38 (31%) never use vacuum. Only 29 (24%) report using both instruments frequently. During 2002 no neonatal death related to an operative vaginal delivery was reported while 145 neonatal complications were (3.2%). Major complications were one depressed skull fracture (1/4589) and 14 extensive caput succedaneum (14/4589). Minor complications were cutaneous lesions (124/4589) and facial palsy (6/4589). Vacuum delivery was associated with a significantly higher extensive caput succedaneum rate (P = 0.018) while the only depressed skull fracture observed was related to forceps use. Forceps delivery was associated with a significantly higher cutaneous lesions rate (P < 0.001). DISCUSSION AND CONCLUSIONS: This study showed that, in 2002, operative vaginal deliveries still represent a significant amount of vaginal deliveries, a majority of obstetricians do not use both instrument and neonatal associated complications are frequent (3.2%) but rarely severe. Therefore, we believe that every method that allows a safe teaching of operative delivery should be promoted.

Adult↗
PubMed1998

[The evaluation of forceps delivery complications].

141 forceps deliveries were studied. The frequency, number and type of complications were evaluated. Decreased number of forceps delivery and relatively high risk of complications in mothers and neonates were indicated. More then half of examined women in childbirth had various injuries of their birth canal. About 30% of new-borns were born with different types of birth's complications. Our results indicate that after forceps delivery the women and new-borns require special care in the perinatal period due to relatively high risk of serious complications.

Female↗
PubMed2005

Pregnancies and deliveries in patients with Charcot-Marie-Tooth disease.

OBJECTIVE: To investigate the effect of maternal Charcot-Marie-Tooth disease (CMT) on pregnancy and delivery. METHODS: Data from the Medical Birth Registry of Norway 1967 to 2002 were surveyed. This registry has compulsory notification of all births. One hundred eight births by mothers with CMT were identified. The reference group consisted of all 2.1 million births by mothers without CMT. RESULTS: Women with CMT had a higher occurrence of presentation anomalies (9.3 vs 4.5%; p = 0.04) and bleeding post partum (12.0 vs 5.8%; p = 0.02). The rate of operative delivery was twice that of the reference group (29.6 vs 15.3%; p = 0.002), and forceps was used three times as often in the CMT group (9.3 vs 2.7; p < 0.001). The majority of CMT cesarean sections were emergency sections. CONCLUSION: Charcot-Marie-Tooth disease increases the risk for complications during delivery, which is linked to a higher occurrence of emergency interventions during birth.

Adult↗
PubMed1987

Method and route of delivery in the low birth weight vertex presentation correlated with early periventricular/intraventricular hemorrhage.

Two hundred eighty patients with vertex presentation who were in spontaneous labor and delivered neonates weighing 2 kg or less were examined for early ultrasound evidence of periventricular/intraventricular hemorrhage. This was correlated retrospectively with delivery route (cesarean section versus vaginal delivery) and delivery method (low forceps delivery versus normal spontaneous delivery) in the group born vaginally. No correlation was evident between early periventricular/intraventricular hemorrhage and delivery route or method.

Apgar Score↗
PubMed1993

Save the Barton forceps.

The old Barton forceps is uniquely designed for a new use. The curves of the blades and shanks make them useful for assisting in repeat cesarean deliveries and other cesareans with a high presenting vertex.

Cesarean Section↗
PubMed2005

Soft forceps.

OBJECTIVE: The risk of maternal and fetal trauma and, chiefly, the fear of law suits, have contributed to a significant decline in rates of forceps-assisted deliveries and an increase in rates of cesarean sections, especially in the United States. Our experience with gas-sterilized forceps blades covered with a soft rubber coating--the "soft" forceps--is described. METHOD: Ninety-six women who required a forceps-assisted delivery for standard indications were randomly allocated to 2 groups. There were 51 women in the regular forceps group and 45 women in the soft forceps group. Low forceps delivery with a Simpson instrument was used in all cases. The groups were compared for fetal injury. RESULTS: The rates of severe facial abrasion and minimal marking were 4.1% and 61%, respectively, in the regular forceps group and 1.9% and 34% in the soft forceps group. CONCLUSION: The soft forceps may reduce the rates of neonatal facial abrasion and skin bruises. The forceps should be further perfected, as well as vacuum extractors; they should both continue to be part of the obstetrician's armamentarium.

Contusions↗
PubMed1986

Reconsideration of head compression and intraventricular hemorrhage in the vertex very-low-birth-weight fetus.

The relationship between fetal head compression and the occurrence of intraventricular hemorrhage was examined in 101 very-low-birth-weight (500 to 1500 g) vertex neonates. Peripartum events related to head compression, including parity, rupture of membranes, labor, episiotomy, use of forceps, and cesarean birth were not significantly related to intraventricular hemorrhage. A birth weight of less than 1250 g, neonatal depression (one minute Apgar score less than 7), respiratory distress syndrome, and neonatal mortality were significantly associated with intraventricular hemorrhage (P less than .05). These findings suggest that head compression in the vertex very-low-birth-weight fetus, as encountered in current obstetric practice, is not a major determinant of intraventricular hemorrhage. When premature delivery is inevitable, focusing on efforts to avoid a depressed one-minute Apgar score appears to be a more promising approach for the prevention of intraventricular hemorrhage than routinely using cesarean birth.

Adolescent↗
PubMed2000

Birth trauma: short and long term effects of forceps delivery compared with spontaneous delivery on various pelvic floor parameters.

OBJECTIVE: To compare the effects of forceps delivery and spontaneous delivery on pelvic floor functions in nulliparous women. DESIGN: A longitudinal prospective study with investigations during the first pregnancy, 10 weeks and 10 months after delivery. SETTING: Antenatal clinic in a teaching hospital. POPULATION: One hundred and seven patients aged 28 +/- 4 years, divided into those with forceps (n = 25) or spontaneous (n = 82) delivery. METHODS: Investigations with a questionnaire, clinical examination, assessment of bladder neck behaviour, urethral sphincter function, intra-vaginal/intra-anal pressures during pelvic floor contractions. RESULTS: The incidence of stress urinary incontinence was similar in both groups at 9 weeks (32% vs 21%, P = 0.3) and 10 months (20% vs 15%, P = 0.6) after delivery, as was the incidence of faecal incontinence (9 weeks: 8% vs 4%, P = 0.9; 10 months: 4% vs 5%, P = 1) and the decreased sexual response at 10 months (12% vs 18%, P = 0.6). Bladder neck behaviour, urethral sphincter function and intra-vaginal and intra-anal pressures were also similar in the two groups. However, 10 months after delivery, the incidence of a weak pelvic floor (20% vs 6%, P = 0.05) and the decrease in intra-anal pressure between the pre- and post-delivery values (-17 +/- 28 cm H2O vs 3 +/- 31 cm H2O, P = 0.04) were significantly greater in the forceps-delivered women. CONCLUSIONS: Forceps delivery is not responsible for a higher incidence of pelvic floor complaints or greater changes in bladder neck behaviour or urethral sphincter functions. However, patients with forceps delivery have a significantly greater decrease in intra-anal pressure and a greater incidence of a weak pelvic floor.

Adult↗
PubMedDate not supplied

Soluble intercellular adhesion molecule 1 in umbilical cord serum: potential for the diagnosis of neonatal infections.

OBJECTIVE: To evaluate the diagnostic relevance to neonatal infections of the soluble intercellular adhesion molecule 1 (sICAM-1) cord serum level. METHODS: The case-control study included 66 term newborn infants with and without risk factors for neonatal infections. Cord blood serum determinations of white blood cell count, C-reactive protein, fibrinogen, and sICAM-1 were systematically performed associated with bacterial cultures from placenta, ears, and gastric fluids. RESULTS: 6 of 33 infants (18.2%) with risk factors were infected, and 13 (39.4%) were colonized. Two infants included in the group without infection risk factors (n = 33) were colonized. No difference in sICAM-1 cord serum levels was found according to the presence of premature rupture of membrane, fetal tachycardia >160 bpm, meconial amniotic fluid, and duration of labour >10 h. No difference in sICAM-1 was noted between infected and non-infected infants. The cord serum levels of sICAM-1 were significantly higher in infants after forceps extraction (p = 0.01). A correlation was observed between sICAM-1 and C-reactive protein cord serum levels (p = 0.004, r = 0.371) and between sICAM-1 level and neutrophil count (p = 0.01, r = 0.489). CONCLUSIONS: Our results suggest that cord serum sICAM-1 determinations have no diagnostic relevance to neonatal infection. The increase of sICAM-1 cord serum levels in infants after forceps extraction suggests its potential to evaluate cerebral trauma or hypoxia.

Bacteria↗
PubMed2001

Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.

The authors conducted a population-based historical cohort study in the Canadian province of Quebec to assess the maternal and infant outcomes associated with vacuum extraction and forceps deliveries. The study database contains information on 305,391 mother-infant dyads (linked by a common institutional code and hospital chart number) for singleton live vaginal births with a nonbreech presentation at the gestational age of 37 or more completed weeks and a birth weight between 2,500 and 4,000 g during fiscal years 1991/1992 to 1995/1996. Of the births, 31,015 were delivered by vacuum extraction, and 18,727 were delivered by forceps. Compared with delivery by forceps, the adjusted risk ratios for third-/fourth-degree perineal laceration, intracranial hemorrhage, subdural or cerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, cephalhematoma, and neonatal in-hospital death were 0.48 (95% confidence interval: 0.45, 0.50), 1.28 (95% confidence interval: 0.73, 2.25), 0.97 (95% confidence interval: 0.49, 1.93), 0.99 (95% confidence interval: 0.16, 5.97), 5.44 (confidence interval: 1.26, 23.43), 2.02 (95% confidence interval: 1.89, 2.16), and 0.93 (95% confidence interval: 0.32, 2.70), respectively. The authors conclude that vacuum extraction causes less maternal trauma but may increase the risk of cephalhematoma and certain types of intracranial hemorrhage (e.g., subarachnoid hemorrhage).

Adult↗
PubMed2005

The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries.

OBJECTIVE: A forceps-assisted vaginal delivery is a well-recognized risk factor for anal sphincter injury. Some studies have shown that occiput posterior (OP) fetal head position is also associated with an increased risk for third- or fourth-degree lacerations. The objective of this study was to assess whether OP position confers an incrementally increased risk for anal sphincter injury above that present with forceps deliveries. STUDY DESIGN: This was a retrospective cohort study of 588 singleton, cephalic, forceps-assisted vaginal deliveries performed at our institution between January 1996 and October 2003. Maternal demographics, labor and delivery characteristics, and neonatal factors were examined. Statistical analysis consisted of univariate statistics, Student t test, chi2, and logistic regression. RESULTS: The prevalence of occiput anterior (OA) and OP positions was 88.4% and 11.6%, respectively. The groups were similar in age, marital status, body mass index, use of epidural, frequency of inductions, episiotomies, and shoulder dystocias. The OA group had a higher frequency of rotational forceps (16.2% vs 5.9%, P = .03), greater birth weights (3304 +/- 526 g vs 3092 +/- 777 g, P = .004), and a larger percentage of white women (48.8% vs 34.3%, P = .04). Overall, 35% of forceps deliveries resulted in a third- or fourth-degree laceration. Anal sphincter injury occurred significantly more often in the OP group compared with the OA group (51.5% vs 32.9%, P = .003), giving an odds ratio of 2.2 (CI: 1.3-3.6). In a logistic regression model that controlled for occiput posterior position, maternal body mass index, race, length of second stage, episiotomy, birth weight, and rotational forceps, OP head position was 3.1 (CI: 1.6-6.2) times more likely to be associated with anal sphincter injury than OA head position. CONCLUSION: Forceps-assisted vaginal deliveries have been associated with a greater risk for anal sphincter injury. Within this population of forceps deliveries, an OP position further increases the risk of third- or fourth-degree lacerations when compared with an OA position.

Adult↗