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PubMed1993

Epithelial transformation of the corneal endothelium in forceps birth-injury-associated keratopathy.

Using light and electron microscopy, we studied four keratectomy specimens obtained by penetrating keratoplasty from four patients (ages 33-54 years; mean age: 43 years old) who had clinical evidence of Descemet's folds and bullous keratopathy after ruptures in Descemet's membrane after forceps injury at birth. Histopathologically, three patients showed the typical features of forceps birth injury: Descemet's membrane at the margin of the rupture was folded and assumed a scroll-shape configuration. The fourth patient showed clusters of proliferated endothelial cells at the site of two ruptures, and from one site of the ruptures, these cells invaded into Descemet's membrane, forming a new basement membrane. Transmission electron microscopy revealed that these proliferated cells were epithelial-like cells characterized by desmosomal junctions, basal lamina, numerous microvilli, and 8-nm cytoplasmic filaments. The epithelial transformation of the corneal endothelium was identified in cases of posterior polymorphous dystrophy and assumed to be specific for this entity. The findings in our fourth patient represent the first documentation of epithelial-like cells on the posterior corneal surface in forceps birth-injury-associated keratopathy. Our results suggest that epithelial transformation may be a nonspecific reaction of the young cornea to various stimuli.

Adult↗

PubMed1976

Perinatal mortality after epidural analgesia.

A retrospective survey has been carried out of 6442 births during 1973-1974 in Cardiff. Lumbar epidural block had been administered to the mothers of 13-7% (885) of the births, the principle indication being relief of pain. In the management of the mother special emphasis was laid upon avoiding aorto-caval compression. The perinatal mortality associated with epidural block (14-8 per 1000) was not significantly different from that after other forms of analgesia (19-2 per 1000). There were less first week deaths in babies weighing less than 2-5 kg after epidural block (0 of 45) than in those who had other methods of pain relief (41 of 414) (P = 0-023). The choice of maternal medication did not influence the perinatal mortality rate of the immature baby, but there is a positive but non-significant, trend in favour of epidural block in the premature baby. This improvement in mortality could simply be related to the increased use of forceps delivery associated with epidural block. A controlled trial of epidural block is therefore indicated in the management of the premature fetus. In babies over 2-5 kg, or, those who were immature, epidural block was not associated with a reduction or increase in perinatal mortality.

Adult↗

PubMed1980

Delivery of the growth-retarded infant.

Birth weight percentiles for gestational age were defined in 10,896 normal single live births of known maturity. Six hundred ninety-six infants with birth weights below the tenth percentile were compared with 574 controls to assess the effects of growth retardation and mode of delivery on fetal condition at birth. An Apgar score of less than 5 at 5 minutes was present in 112 growth-retarded infants and 50 normal infants; clinical fetal distress was present in 190 growth-retarded infants and 78 normal infants. Thirty growth-retarded infants died, 21 of them after 36 weeks' gestation. Apgar scores of less than 5 at 1 and 5 minutes were more often seen in immature infants, but the additional effect of growth retardation was not seen in this group. Forty-nine percent of the growth-retarded infants had low 5-minute Apgar scores after delivery by elective cesarean section, although less mature than the control group. Normal and breech deliveries were also more commonly associated with low scoring in growth-retarded infants, although immaturity was rare. Rotational forceps delivery was well tolerated. Breech and normal vertex deliveries were associated with depression at birth and increased perinatal mortality and morbidity in the growth-retarded infant, irrespective of maturity. Delivery by elective cesarean section was not shown to reverse this trend.

Apgar Score↗

PubMed1998

Does magnesium sulfate given for prevention of eclampsia affect the outcome of labor?

OBJECTIVE: The purpose of this study was to determine whether magnesium sulfate given for prevention of eclampsia affected labor outcomes compared with phenytoin, which is not known to impede uterine activity when given in anticonvulsant doses. STUDY DESIGN: Secondary analysis was performed of a study of women with pregnancy-induced hypertension who were admitted for delivery and randomly assigned to receive either magnesium sulfate or phenytoin for eclampsia prophylaxis. Nulliparous women with a singleton pregnancy in cephalic presentation at term were selected for analysis in an effort to limit the influence of confounding variables such as preterm birth and malpresentations on labor management and outcomes. Similarly, women who had severe preeclampsia and who received labor epidural analgesia were excluded. RESULTS: A total of 2138 women were randomized to receive magnesium sulfate or phenytoin in the primary study. A total of 905 nulliparous women met the inclusion criteria for this secondary analysis; 480 had been randomized to phenytoin and 425 were given magnesium sulfate. The two groups were similar demographically. Labor outcomes such as (1) oxytocin stimulation, (2) admission-to-delivery intervals, (3) prolonged second-stage labor, (4) forceps delivery, and (5) cesarean delivery were not affected by maternal treatment with magnesium sulfate. CONCLUSION: Compared with phenytoin, magnesium sulfate given for intrapartum treatment of pregnancy-induced hypertension does not significantly affect labor outcomes.

Adult↗

PubMed1987

Rotational delivery with Kielland's forceps.

A retrospective study over 15 months showed that 10.7% of primigravid women and 1.6% of multigravid women were delivered by Kielland's forceps: a total of 145 babies. The successful vaginal delivery rate for attempted Kielland's forceps was 96.7%. The neonatal outcome was good and there were no perinatal deaths. Traumatic injuries were present in 7.6% of babies and were minor. The data show that even in the presence of fetal distress, Kielland's forceps can be safely employed for rotational delivery from the mid-pelvic cavity. This approach can avoid some caesarean sections without undue risk to the baby, the caesarean rate being 9.5%. As 10.7% of primigravid women required rotational delivery with Kielland's forceps, it is desirable that primigravid women should be cared for by obstetricians who are skilled in the use of the instrument, in order to maintain a low caesarean section rate in this group, with a good neonatal outcome.

Adult↗

PubMedDate not supplied

[Parametrial hematoma after forceps delivery].

We report on a large intraligamentous haematoma developed after low forceps delivery. The diagnosis was made from symptoms and signs, rectal examination, and sonographic findings. The haematoma was incised and clots were evacuated by laparotomy. The bleeding vessel could be ligated. The 31-year-old woman left our hospital on the 12th postoperative day.

Adult↗

PubMed2003

Failed individual and sequential instrumental vaginal delivery: contributing risk factors and maternal-neonatal complications.

BACKGROUND: To identify the risk factors for failed instrumental vaginal delivery, and to compare maternal and neonatal morbidity associated with failed individual and sequential instruments used. DESIGN: A retrospective case-control study. METHODS: From January 1995 to June 2001, there were 39 508 live births at >37 weeks' gestation of which 2628 (6.7%) instrumental vaginal deliveries were performed, 1723 (4.4%) were vacuum extractions and 905 (2.3%) were forceps. A total of 155/2628 (5.9%) patients who had failed instrumental delivery were matched with 204 patients who had successful instrumental delivery. The patients were divided into five groups. Group I (n = 129) had failed vacuum extraction, group II (n = 13) failed forceps, group III (n = 13) failed both (i.e. failed attempt at both instruments sequentially), group IV (n = 138) had successful vacuum extraction and group V (n = 66) successful forceps. RESULTS: The failure rate for vacuum extractions 129/1723 (7.5%) was significantly higher than that for forceps 13/905 (1.4%) [odds ratio (OR) = 5.6, 95% CI 3-10.3]. There were no significant differences in all maternal complications (25.5% vs. 26.6%) between vacuum (groups I and IV) and forceps (groups II and V) assisted deliveries. There were more maternal complications in group III (46.2%) than in groups I (35.7%), II (23.1%) and V (27.3%) that did not reach statistical significance but were significantly higher than in group IV (15.9%, OR = 4.5, 95% CI 1.2-16.9). There was a significantly higher rate of all fetal complications in group III [11/13 (84.6%)] than in groups I [69/129 (53.5%)], II [7/13 (53.8%)], IV [35/138 (25.4%)] and V [22/66 (33.3%)] (OR = 4.8, 95% CI 0.9-19.9). CONCLUSIONS: Applying the instrument at < or =0 fetal station, nulliparous women, history of previous cesarean section and fetal head other than occipitoanterior position were risk factors for failed instrumental delivery. Sequential use of instrumental delivery carries a significantly higher neonatal morbidity than when a single instrument is used.

Adult↗

PubMed1990

[Relations between psycho-physical acceleration and modern obstetrics].

In the highly developed countries, an acceleration of human growth and an increase in body length can be observed. The weight and length at birth are also increasing, which can be proved by our own investigation. Up to now, the theories explaining this phenomena are insufficient, because they assume the transmission of genetically acquired qualities. The reason for the acceleration is to be considered in the advancement of obstetrics as follows: Obstetrical handling, forceps and caesarean section permit the delivery of large babies, which were often lethal for mother and child. This led to an increase in the frequency of genetic developments for greater body length and weight at birth, which had formerly been limited by the high mortality rate. The trend towards larger babies is caused by an evolutionary selection of an enlargement of the brain, which must reach a certain minimum size by the time of birth. The relative enlargement of the newborn skull, made possible by advanced obstetrics, permits such increased birth weight and length. It also leads to an acceleration of growth and taller adults. The consequence of larger babies is an increasing frequency of obstetrical operations.

Birth Weight↗

PubMed1991

Validation of the 1988 ACOG forceps classification system.

In February 1988, an ACOG Committee Opinion substantially revised the classification of forceps operations. The revision addressed two significant shortcomings of the old system: Outlet forceps had been defined too narrowly and midforceps too imprecisely. We now report the results of a prospective study of 357 forceps deliveries classified using each system. Allowing up to 45 degrees of rotation in an outlet forceps delivery did not increase morbidity measured by any criterion. Dividing the old midforceps group by precisely identifying station and rotation permitted greater stratification of the risks of short-term neonatal and maternal morbidity. We conclude that our results validate the 1988 classification scheme.

Birth Injuries↗

PubMedDate not supplied

Intrathecal morphine as analgesia for labor pain.

In this descriptive study of intrathecal morphine sulfate used for pain control during labor, 49 parturients received morphine intrathecally, 78 were administered butorphanol tartrate (Stadol), and 34 received no analgesia. Significant differences for the intrathecal group included: (1) decreased requirement of nitrous oxide for delivery, (2) lower number of doses of postpartum intramuscular pain medication, and (3) increased use of forceps. The intrathecal morphine group showed no prolongation of labor and no major side effects in mothers or newborns. The results suggest that the use of lower levels of intrathecal morphine sulfate (0.5 mg) is as safe and effective as the more traditional intravenous analgesia for labor.

Anesthesia, Intravenous↗

PubMed1987

Cephalhaematoma: a 10-year review.

The incidence of cephalhaematoma at the Mercy Maternity Hospital over a 10-year period was 2.5%; of the 1,030 infants 68.4% were born to primiparas, 65.6% were males, the majority (91.1%) were between 37 and 42 weeks' gestation and 3,000 and 4,000 g birth-weight (71.6%). Forceps delivery and vacuum extraction were associated with increased incidences of cephalhaematoma (5.1% and 22.9% respectively), and the incidence was slightly increased (3.8%) when a scalp electrode had been applied. Hyperbilirubinaemia was more prevalent (12.9%) in infants with a cephalhaematoma as was exchange transfusion (0.8%) and the need for phototherapy (4.9%).

Birth Injuries↗

PubMed1999

[Labor in the squatting position. [A randomized trial comparing the squatting position with the classical position for the expulsion phase].

OBJECTIVE OF STUDY: To evaluate the influence of a vertical delivery position squatting during expulsion, studying different parameters such as duration of expulsion, neonatal status, delivery mode, frequency of hemorrhagia, perineum status and patient comfort. TYPE OF STUDY: Randomized, unicentric, comparative, open, prospective. MATERIAL AND METHOD: After a retrospective study determining feasibility, 240 patients were randomized to equal 2 groups in which the delivery was performed in squat position versus in lithotomy position. All the above described parameters were recorded and treated by the Epi-Info software package using Student t test, chi 2 and Kruskall-Wallis test. RESULTS: Our study has shown a tendency to shorten the length of the expulsion phase and a reduced use of forceps in the squat position. This is consistent with other studies published in the literature. We would like to emphasize that even if it does not show a medical advantage on the studied parameters, the squat position is not deleterious and can provide a better comfort for the patients who want to use it.

Delivery, Obstetric↗

PubMed1979

[The effect of antibiotic prophylaxis in vaginal obstetric procedures (author's transl)].

202 cases of vaginal obstetric procedures (forceps and vacuum extraction, breech delivery and manual removal) were reviewed with regard to assessing the value of prophylactic administration of antibiotics. Criteria for the evaluation were fever post partum, duration of stay in hospital and involution of the uterus. The results showed that the prophylactic administration of antibiotics had no significant effect on these parameters, with or without the simultaneous administration of oxytocics. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in vaginal obstetric procedures. Scrupulous aseptic precautions during all vaginal or intrauterine procedures are considered essential for the prevention of infection.

Adult↗

PubMed1992

The effects of maternal epidural anesthesia on neonatal behavior during the first month.

The effects of maternal epidural anesthesia with bupivacaine on the infant's performance on the Neonatal Behavioral Assessment Scale (NBAS) over the first month of life were examined. 20 non-medicated infants were matched for biomedical and demographic variables with 20 infants delivered with bupivacaine epidural anesthesia. The NBAS was administered on days 1, 3, 7 and 28. The epidural group showed poorer performance on the orientation and motor clusters during the first month of life. Epidural mothers reported spending less time with their infants while in the hospital; post hoc analyses showed that they had longer labor, more forceps deliveries and a greater amount of oxytocin. Controlling for the effects of these medical variables, a dose effect was found for the mean orientation and motor cluster scores. The results are discussed in terms of possible effects of the infant's early disorganization on the mother-infant interaction.

Anesthesia, Epidural↗

PubMed2006

Recurrent pneumothorax in pregnancy: what should we do after placing an intercostal drain.

Recurrent pneumothorax is rare during pregnancy. We describe a Chinese woman, with a history of spontaneous pneumothorax managed with an intercostal drain, who developed a recurrent pneumothorax during her 32nd week of pregnancy. There is no consensus on management in this situation. We review the literature and discuss different management approaches. Thirty-six cases of antepartum pneumothorax have been reported in 31 case reports. An intercostal drain only (n=11) or surgeries (thoracotomy, n=9; or video-assisted thoracoscopy, n=2) were common treatment options with no surgical complications reported. Twenty-two (61%) patients progressed to a normal vaginal delivery, while the rest required forceps delivery (22%) or Caesarean section (14%). No single treatment option outweighed the others. There were no maternal or foetal complications reported in those who underwent antepartum surgical intervention. Surgical management of recurrent pneumothorax during pregnancy is well tolerated.

Adult↗

PubMed1990

The influence of birth weight on labor in nulliparas.

The purpose of this study was to examine the hypothesis that dystocia in nulliparas is directly related to birth weight. The study was confined to the first 1000 nulliparas delivered in 1988 who went into labor after 37 weeks' gestation with a single live fetus and cephalic presentation. The management of labor was standardized. As birth weight increased, there was an increase in the mean duration of labor and of the second stage of labor, in the incidence of oxytocin augmentation, and in the incidence of both cesarean and forceps delivery for dystocia. The direct relationship between birth weight and the mean duration of labor was independent of gestation and oxytocin augmentation. These findings suggest that birth weight is an important factor in the development of dystocia in nulliparas.

Birth Weight↗

PubMed1978

[Parturition under peridural anesthesia (author's transl)].

Basing on a study of 205 "matched pairs", it is shown to what extent peridural anesthesia (PA) influences the course of parturition, the type of termination of birth, and the intrapartal and post-partal condition of the child. The method of PA application is accurately described in the section "Material and Methods". The first stage of labor, or period of dilatation (PD) is not in any way effected by PA. However, PA will almost double the expulsion period (EP). Hence, elective termination of birth via technically simple, complication-free outlet forceps is usually propagated and employed significantly more often. Emergency sections or delivery by forceps due to mandatory indication, are not more frequent under PA than otherwise. The intrapartal condition of the child, measured with the cardiotocogram employing in the score according to Hammacher et al. (6) before and after application of PA, as well as during the last 30 minutes of birth (final score), is influenced only irrelevantly. The Apgar scores one minute and five minutes post partum, as well as the arterial umbilical cord pH values, do not differ significantly between the peridural and the control groups. The authors agree with the widespread opinion that, at the present moment, PA is the best obstetric analgesic method with simultaneous maximum possible safety for the fetus.

Anesthesia, Epidural↗

PubMed1987

Fear of failure: a place for the trial of instrumental delivery.

The safety of performing potentially difficult midcavity forceps or vacuum extractions, as trials of instrumental delivery was assessed retrospectively. Successful vaginal delivery was achieved in 61% of 122 patients with delay in the second stage who had a trial of instrumental delivery performed in an operating theatre with full preparations to proceed to caesarean section. The outcome was compared with that in 42 patients who were delivered for the same indication, by primary caesarean section, without prior instrumentation. Transient fetal trauma occurred only in the trials of instrumental delivery, and there was no significant difference in immediate neonatal or maternal morbidity. In another group of 61 patients instrumental delivery was attempted without full preparations for possible caesarean section and when unexpected difficulty arose, the forceps or vacuum extractor were abandoned in favour of caesarean section. Within this group of unexpected failures of instrumentation there were significantly more babies with low Apgar scores, delayed onset of respirations or needing intubation. A carefully conducted trial of instrumental delivery is an acceptable alternative to caesarean section for delay in the second stage due to a potentially difficult midcavity arrest.

Adult↗