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PubMed1984

Plasma haptoglobin levels in vacuum extracted neonates.

In order to examine the pathogenesis of neonatal hyperbilirubinemia associated with vacuum extraction, we have compared plasma haptoglobin and bilirubin levels and blood hematocrits of vacuum extracted neonates with those of newborns who underwent a normal vaginal delivery. Plasma haptoglobin and blood hematocrits of the 12 vacuum patients measured on the third day of life were significantly lower (21.7 +/- 5.3 vs. 46.5 +/- 7.5 mg%; p value less than 0.01 and 52.3 +/- 1.3 vs. 59.7 +/- 1.8%; p value less than 0.005, respectively) than the 12 control patients (values are mean +/- SEM). This trend was apparent whether or not cephalhematoma was present after vacuum extraction: However, the mean bilirubin level was significantly higher than the controls only when cephalhematoma was present. Those results suggest that the higher incidence of neonatal hyperbilirubinemia previously observed after vacuum extraction, is the result of an increased hemolysis of blood sequestered in scalp lesions. Since evidence for enhanced RBC destruction has been demonstrated whether or not cephalhematoma was present, the possibility of hyperbilirubinemia should be anticipated in any case of vacuum delivery.

Bilirubin↗
PubMed2002

Effect of delivery mode on maternal-infant transmission of hepatitis B virus by immunoprophylaxis.

OBJECTIVE: To study the effect of different delivery modes on immunoprophylaxis efficacy so as to clarify whether or not cesarean section reduces immunoprophylaxis failure. METHODS: Mothers with positive hepatitis B surface antigen (HBsAg) were selected in the third trimester of pregnancy. Their babies were inoculated with hepatitis B immunoglobulin at birth and hepatitis B vaccine at 1, 2 and 7 months of age. HBsAg and its antibodies (anti-HBs) were tested at 1, 4, 7, and 12 months of age, then followed up yearly. RESULTS: A total of 301 babies entered the study, including 144 born by normal spontaneous vaginal delivery, 40 by obstetric forceps or vacuum extraction, and 117 by cesarean section. The incidence of mother's HBeAg positivity or baby's gender constitution was comparable between the three groups. There were no significant differences in the positive rate of anti-HBs or HBsAg at follow-up periods among the three groups. At 12 months of age, anti-HBs could be detected in 78.9% of the babies born by normal vaginal delivery, 84.6% of the babies by forceps or vacuum extraction, and 86.4% of the babies by cesarean section. The positive rate of HBsAg was 8.1%, 7.7%, 9.7%, and chronic HBV infection incidence was 7.3%, 7.7%, 6.8% respectively. CONCLUSIONS: There are no significant effects of delivery mode on the interruption of HBV maternal-baby transmission by immunoprophylaxis. Cesarean section does not reduce the incidence of immunoprophylaxis failure.

Cesarean Section↗
PubMed1996

Forceps and vacuum delivery: a survey of North American residency programs.

OBJECTIVE: To document resident instruction in operative vaginal delivery by forceps and vacuum. METHODS: A survey was sent to all 291 obstetrics-gynecology training programs in the United States and Canada. RESULTS: The overall response rate was 72% (210 of 291). Most programs (60%) have an operative vaginal delivery rate of 10% or less. Nearly all of the responding programs (199 of 209, 95%) teach operative vaginal delivery via the vacuum route; metallic cups are used in only 14% of centers. Forceps are the primary instrument in most programs (68%), but nearly one-third of responding centers use the vacuum method more often than forceps. Instruction in midpelvic operative vaginal delivery is offered in 64% of the programs, with forceps being more common by nearly a two-to-one ratio. Deep transverse arrest is handled initially by forceps by half of the respondents, whereas 28 and 22% would proceed with cesarean or attempt a vacuum extraction, respectively. CONCLUSION: Instruction in both types of operative vaginal delivery is found in most programs. The forceps are used more commonly, but vacuum is the preferred instrument in about one-third of training programs. Instruction in midpelvic delivery is offered in 64% of programs, but we noted a declining trend.

Canada↗
PubMed1979

A comparison of different methods of instrumental delivery based on electronic measurements of compression and traction.

Electronic measurements of compression, using a hydrostatic technique, were made during 44 normal deliveries and compared with the values obtained during 32 deliveries using Kielland's forceps, 21 using Neville Barnes' forceps, 48 using Moolgaoker's adjustable forceps, and 26 using Malmstrom's vacuum extractor. Electronic recordings of traction, using strain gauges, were made simultaneously during all the instrumental deliveries except those with Kielland's forceps. By exercising suitable controls over most of the multiple factors operating at the time of any delivery the authors were able to compare objectively the efficiency of the different methods of instrumental delivery. Smaller forces of compression and traction were exerted and better Apgar scores were recorded in infants delivered with the adjustable forceps than in infants delivered with the other instruments. The superiority of the adjustable forceps was most noticeable during midcavity deliveries of the malrotated head.

Apgar Score↗
PubMed1994

Operative vaginal delivery. ACOG Technical Bulletin Number 196-- August 1994 (replaces No. 152, February 1991).

The scope of operative vaginal delivery as described in this bulletin includes the use of forceps and vacuum extraction as well as the management of shoulder dystocia and internal podalic version. While knowledge of the material presented is necessary to perform operative vaginal deliveries, it alone is not sufficient to achieve optimal maternal and perinatal outcome. Technical skill should be taught during residency training and maintained through use in clinical practice.

Anesthesia, Obstetrical↗