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PubMed1998

[Indications and prognosis of forceps delivery at the University Hospital Center of Dakar].

Based on a study of 382 cases registered in a five years periods (1992-1996), the prevalence of forceps delivery is evaluated at 16 per 1000 deliveries. Averagely these are young (24.5 years), primipare (63%) at term and having problems of abnormal labour. The mains indications are: assistance of expulsion (47.1%), severe foetal distress (15.6%), scarred uterus (15.2%) and eclampsia (8.9%). The most frequent applications are the occipito-pubic grasp (51.3%) and left anterior occipito-iliac grasp (34.8). The maternal morbidity prognosis (6%) is represented by cervical or vaginal traumas and infections. The neonatal prognosis is marked by neonatal mortality rate of 50 per 1000 of life deliveries and by a morbidity rate of 3.4% essentially represented by cutaneous lesions.

Adolescent↗

PubMed1981

Caesarean section: a 15-year review of changing incidence, indications, and risks.

During 15 years (1965 through 1979), 9,718 cesarean sections were performed at Hutzel Hospital. This report concerns the indications, incidence, morbidity, and mortality. Dystocia, fetal distress, and breech presentations were the most common indications for primary cesarean section. The incidence rose from 9.8% to 16.8% during this study. Forceps deliveries dropped from 47.5% to 12.0% and vaginal breech deliveries decreased from 86% to 35%. Spinal anesthesia was used in 90%. Caesarean section hysterectomies were performed in 128. The most common indications were carcinoma in situ of the cervix, uterine leiomyoma, and hemorrhage. Puerperal sepsis and urinary tract and wound infections were the major causes of morbidity. Perinatal mortality decreased from 40% to 29%. There were 10 maternal deaths. Sepsis was the major cause of death. At least four deaths could have been avoided if ultra-high-risk patients had not been pregnant in the first place.

Adolescent↗

PubMed1976

Ergometrine, oxytocin and extradural analgesia.

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.

Anesthesia, Epidural↗

PubMed1997

Incontinence during pregnancy. Prevalence and opportunities for continence promotion.

A cross-sectional study using a structure interview was conducted with 304 women in the postnatal ward of a large NSW teaching hospital. Women were asked about any incontinence experienced in the last month of pregnancy, and about advice and interventions for bladder control or incontinence they had received during pregnancy. Sixty four per cent of women reported incontinence during pregnancy. Compared to women with no prior deliveries, those with a previous forceps delivery were 10 times more likely to experience incontinence, and with prior vaginal deliveries 4 times more likely to experience incontinence. Women who reported experiencing bouts of coughing on a regular basis during pregnancy were 4 times more likely to experience incontinence than those who did not. While 68% of the women reported being examined vaginally at least once during pregnancy, only 6% of the sample reported having their pelvic floor muscles tested during routine vaginal examination. Twenty three per cent of women reported having spoken with a healthcare professional regarding loss of bladder control. The results indicate that opportunities for continence promotion are not being utilized.

Adolescent↗

PubMed1983

The outcome of prolonged labor as defined by partography and the use of oxytocin: a descriptive study.

A descriptive study of 300 consecutive spontaneous labors in primigravid patients whose pregnancies were of 37 or more weeks' gestation with a singleton fetus in the vertex presentation, showed a cesarean section rate of 13%, a forceps delivery rate of 49%, and a spontaneous delivery rate of 38%. Oxytocin was used in 17% and epidural analgesia was used in 75% of the patients. The median rate for cervical dilatation for those women with spontaneous deliveries was 2 cm/hr (interquartile range = 1.5 to 3.3 cm/hr) and for those delivered with forceps, 1.2 cm/hr (interquartile range = 0.9 to 1.8 cm/hr). When labor was prolonged by 4 hours or more, the cesarean section rate rose to 34%. Oxytocin was used in only 41% of these patients. Of 23 women delivered by cesarean section for dystocia/disproportion, only nine received oxytocin. From the low incidence of low Apgar scores in all labor groups from this series, there would not appear to be a fetal advantage to earlier intervention. Although the suggestion from this study is that oxytocin administration when labor is prolonged by 4 hours will reduce the need for cesarean section, the true value of such an intervention can be tested only by a randomized controlled trial.

Adolescent↗

PubMed1998

The effects of birth on urinary continence mechanisms and other pelvic-floor characteristics.

OBJECTIVE: To determine the effects of delivery on bladder and anorectal functions. METHODS: One hundred forty-nine nulliparas were studied once during pregnancy and again about 9 weeks after delivery by means of questionnaire, clinical examination, perineal sonography, urethral pressure profiles, and recording of intravaginal and intra-anal pressures during pelvic-floor contraction. RESULTS: Stress urinary incontinence was present in 46 patients (31%) during pregnancy and persisted in ten of them after delivery. After vaginal delivery, urinary and fecal incontinence were present in 36% and 4% of forceps-delivered women, respectively, and in 21% and 5.5% of spontaneously delivered women. Bladder neck mobility was increased significantly after all vaginal births, whereas bladder neck position at rest was lowered only in forceps-delivered women. Functional urethral length was decreased in the supine and standing positions after spontaneous and forceps deliveries. Otherwise, indices of urethral sphincter function were unchanged or improved after vaginal delivery. A significant decrease in intravaginal pressure and in intra-anal pressure was observed in all vaginally delivered women. The intra-anal pressure decrease correlated significantly with infant weight (r=0.24, P=.01). Women who underwent cesarean had no specific complaints and only slight modifications of these measurements. CONCLUSION: After spontaneous and instrumental deliveries, 21% and 34% of women complained of stress urinary incontinence and 5.5% and 4% reported fecal incontinence, respectively. Substantial bladder neck hypermobility was present together with diminished functional urethral length and intravaginal and intra-anal pressures. Only 22% of patients with stress urinary incontinence during pregnancy had such incontinence after delivery.

Adult↗

PubMed1982

Plasma progesterone in the umbilical vessels at vaginal delivery of term infants.

The influence of stress and related factors on umbilical-cord vessel progesterone concentrations have been investigated in 150 vaginal deliveries. Cord vein progesterone levels were greater in breech deliveries than in forceps deliveries and in vaginal deliveries by maternal effort alone. Within the forceps group there was no difference in cord vessel progesterone concentrations between lift-out, mid-cavity or rotational forceps deliveries. Levels of progesterone were significantly greater in forceps deliveries where the infant was clinically distressed (P less than 0.01). Similarly, within the normal group progesterone levels were greater in a stressed group of infants, where cord vein pH, artery pH, Apgar score at 1 min or birthweight fell below the 10th centile for the study group. No differences in plasma progesterone concentration were found with labour commencing spontaneously or by induction, nor did the sex of the infant appear to influence this hormone. Progesterone levels were higher in samples from primiparae than in those from multiparae due to a small number of primiparae who had excessively long labours and high progesterone concentrations. There was, however, no strong statistical correlation between length of labour and progesterone concentrations.

Breech Presentation↗

PubMed1990

Midline episiotomies: more harm than good?

The association between episiotomy and severe (third- and fourth-degree) perineal lacerations was studied in 24,114 women. The overall rates of severe lacerations were 8.3 and 1.5% for primiparous and multiparous women, respectively. Women who had midline episiotomies were nearly 50 times more likely and women who had mediolateral episiotomies were over eight times more likely to suffer a severe laceration than were women who did not undergo an episiotomy. Severe lacerations were also more common after use of forceps, in occiput transverse and posterior presentations, among women with smaller pelvic outlet measurements or lower prepregnant weight, and with larger fetuses. The same factors that caused a woman to have an increased risk of laceration also made performance of an episiotomy more likely. After statistical adjustment for these risk factors, mediolateral episiotomy was associated with a 2.5-fold reduction in the risk of severe lacerations among primiparous women, and a statistically nonsignificant 2.4-fold increase among multiparous women, compared with no episiotomy. Midline episiotomy was associated with statistically significant 4.2- and 12.8-fold increases in the risk of lacerations among primiparous and multiparous women, respectively. We conclude that the risks and benefits of midline episiotomy should be evaluated in a randomized clinical trial that compares policies of "usual" versus conservative use of episiotomy.

Delivery, Obstetric↗

PubMed1999

Reproductive factors, family history, occupation and risk of urogenital prolapse.

OBJECTIVE: We conducted a case-control study to analyze risk factors for urogenital prolapse requiring surgery. METHODS: Cases were 108 women with a diagnosis of II or III degree uterovaginal prolapse and/or third degree cystocele. Controls were 100 women admitted to the same hospitals as the cases, for acute, non-gynecological, non-neoplastic conditions. RESULTS: Occupation showed an association with urogenital prolapse: in comparison with professional/managerial women, housewives had an odds ratios (OR) of urogenital prolapse of 3.1 (95% confidence interval (CI), 1.6-8.8). Compared with nulliparae, parous women tended to have a higher risk of genital prolapse (OR 2.6, 95% CI 0.9-7.8). In comparison with women reporting no vaginal delivery, the ORs were 3.0 for women reporting one vaginal delivery (95% CI 1.0-9.5), and 4.5 (95% CI 1.6-13.1) for women with two or more vaginal deliveries. Forceps delivery and birthweight were not associated with risk of prolapse after taking into account the effect of number of vaginal deliveries. The risk of urogenital prolapse was higher in women with mother or sisters reporting the condition: the ORs were, respectively, 3.2 (95% CI 1.1-7.6) and 2.4 (95% CI 1.0-5.6) in comparison with women whose mother or sisters reported no prolapse. CONCLUSIONS: Our data support the clinical suggestion that parous women are at a higher risk of prolapse and the risk increases with number of vaginal deliveries. First-degree family history of prolapse seems to increase the risk of prolapse.

Adult↗

PubMed1999

Triggering learning in midwifery.

The delivery of the head with or without forceps may have been quite easy, but more commonly there has been a little difficulty in completing the extension of the head. The hairy scalp slides with reluctance. When the forehead has appeared it is necessary to press back the perineum to deliver the face. Fat cheeks eventually emerge. A double chin has hooked over the posterior commissure, to which it remains tightly opposed. Restitution seldom occurs spontaneously for the head seems incapable of movement as a result of friction with the girdle of contact at the vulva... time passes. The child's face becomes suffused. It endeavours unsuccessfully to breathe. Abdominal efforts by the mother or by her attendants produce no advance, gentle traction is equally unavailing... Usually equanimity forsakes the attendants. They push, they pull. Alarm increases. Eventually, by greater strength of muscle or some infernal struggle, the difficulty seems to be overcome... It dawns upon the attendants that their anxiety was not ill founded.

Adult↗

PubMed1977

Difficult labour as a cause of communicating syringomyelia.

Although some causes of communicating syringomyelia are known most cases of the disease can only be described as idiopathic. The results of a questionnaire suggest a high incidence of difficult labour in the mothers of syringomyelia patients. A high proportion of patients had forceps deliveries, and a high proportion were the first born in their families. Because the validity of taking a birth history at the age of presentation (mean age 40 y, S.D. 14 for this sample) might be questioned, patients admitted with other disorders (mean age 40 y, S.D. 16) were used as a control group. These patients matched the syringomyelia patients in social class and place of birth. It seems likely that birth trauma may be a cause of tonsillar descent through the foramen magnum (ectopia) and of arachnoiditis; both conditions are often present. Once the tonsils become engaged in the foramen magnum, difference between the cranial and spinal pressure may, over the course of several years, cause the tonsils to descend further, thus leading to communicating syringomyelia. Over half these patients have a history of difficult labour and it is possible that birth injury may be a factor even where birth is regarded as normal.

Adult↗

PubMed1981

Visual prognosis in patients with ruptures in Descemet's membrane due to forceps injuries.

Seven patients with Descemet's membrane ruptures associated with a forceps injury to the eye at birth were studied. A complete ophthalmological examination was done on each patient, and two patients had ultrasound measurements of the axial lengths of both eyes. We found that the ruptures in Descemet's membrane were single or multiple vertically oriented breaks associated with high astigmatism along the axis of the breaks and deep amblyopia in all patients. The astigmatic errors were corneal in origin. High myopia was also present in the involved eye and was thought to be axial in all patients. Two patients did have elongated axial lengths demonstrated by ultrasonography. The presence of axial myopia and deep amblyopia may relate to partial occlusion of the involved eye during the early postnatal months. The latter possibility is discussed in light of recent reports of myopia induced by early postnatal occlusion in animals.

Adolescent↗

PubMedDate not supplied

[Labor in the older primipara].

In the Gynecology Department Split's General Medical hospital, during the period of 5 years (1975-1979) examinations were carried out on primiparas (10775 up to the age of 29, then 504 between the ages of 30-34, and 250 older then 35). These patients had pregnancy complications (EPH-gestosis and diabetes mellitus), premature delivery, birth of children with less then 2500 grams, overcarriage, obstetrical intervention (forceps, vacuum extraction, caesarian) section and perinal mortality and morbidity. Premature delivery and the birth of children lighter then 2500 grams is significantly increased between the ages of 30-34, and still increasing after the age of 35. The frequency of EPH--gestosis is increased between the ages of 30 and 34 and still increasing after the age of 35. The significant increase of diabetes in pregnancy becomes evident after the age of 35. Deliveries ended by an operation become very frequent between the ages of 30-34, significantly increasing after the age of 35 (vacuum extraction and caesarean). Perinal morbidity and mortality are significantly increased after the age of 35. The Author's conclusion is that older primiparas are those women who are expecting their first child after the age of 35. Primiparas between the ages of 30-34, because of the higher rate of fetal injury, should be shown more attention in the perinal period.

Adult↗

PubMed1979

Method of delivery and developmental outcome at five years of age.

A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.

Cesarean Section↗

PubMed2005

A randomised controlled trial of biopsy forceps and cannula aspiration for transcervical chorionic villus sampling.

OBJECTIVE: This trial compared two instruments for transcervical chorionic villus sampling (CVS). DESIGN: Randomised controlled trial. SETTING: Regional university prenatal diagnosis and treatment centre. POPULATION: Two hundred women were randomised at 10(+0)-12(+6) weeks of gestation to transcervical CVS using cannula aspiration (CA) or biopsy forceps (BF). METHODS: Women undergoing indicated CVS signed informed consent. Randomisation after decision to perform transcervical CVS. MAIN OUTCOME MEASURES PRIMARY OUTCOME: the rise in maternal serum alpha-fetoprotein (alpha-FP). SECONDARY OUTCOMES: (i) placental trauma (fetomaternal haemorrhage [FMH]); (ii) laboratory, procedure, and cytogenetic results and pregnancy outcomes; (iii) patient and operator satisfaction; and (iv) economic analyses. Analyses were performed by intention to treat. RESULTS: The -FP rise did not differ between groups; there was no other evidence of placental trauma. BF were better tolerated by women, provided culturable tissue, after fewer instrument passes, with greater ease and in less time. BF were associated with cost savings. CONCLUSIONS: Unlike -FP, other markers of FMH were unaltered, questioning the reliability of alpha-FP as an indicator of FMH. Compared with CA, transcervical BF caused comparable placental trauma, appeared to be similarly effective and safe and were preferred by operators and patients.

Biopsy, Needle↗

PubMed2004

Bladder neck mobility and functional evaluation of the pelvic floor in primiparae according to the type of delivery.

In this study, 91 primiparous women were selected, with a period of post-delivery variable from 45 to 60 days. These patients were divided according to the type of delivery into three groups: I--consisting of 32 patients who had vaginal delivery; II--comprised 29 patients who were subjected to forceps; III--formed by 30 women who were subjected to cesarean section. Patients with a previous pregnancy were not included, so that the possible previous alterations of the pelvic floor did not interfere with the present evaluation. Patients with a pre-term pregnancy, fetus below 2,500 g or above 4,000 g, anomalous presentations, twin pregnancy, diabetes mellitus, systhemic arterial hypertension, hypertensive disease specific of pregnancy, endocrinopathies and neuropathies were also excluded. After 45 to 60 days from delivery the patients were subjected to anamnesis, gynecological examination, functional evaluation of the pelvic floor (FEAF), Q-Tip test and ultrasound of the bladder neck. As for the functional evaluation of the pelvic floor, it was observed that the patients with cesarean section presented better indexes compared to those who were subjected to forceps. The Q-Tip test showed that in both the patients from group I and group II bladder neck mobility was greater than in those from group III. Concerning bladder neck topography in relation to public symphysis and its mobility, which were evaluated by ultrasound, it was observed that at rest all the groups had the neck in a supra-pubic position, with no differences among them. Yet, during the required strain, the bladder neck stayed in the infra-pubic position with major frequency in group I. Bladder neck mobility was greater in the vaginal delivery group in relation to the other groups. It was also noticed that the group undergoing cesarean section showed less mobility. The obtained results lead us to conclude that despite the fact that vaginal delivery may cause displacement of the urethro-vesical junction during strain, and consequently greater bladder neck mobility, it is the attending physician's role to minimize the damage to the pelvic floor, thus avoiding the emergence of a predisposing factor to future stress urinary incontinence.

Cesarean Section↗

PubMed2000

Comparison of the length of stage II labor and incidence of forceps and cesarean delivery after epidural infusion of 0.125% bupivacaine with 2 mu/mL fentanyl as compared with 0.0625% bupivacaine with 2 mu/mL fentanyl.

A large, retrospective chart review was conducted to analyze the length of stage II labor and instrumental and cesarean-section delivery rates in nulliparous women who received either 0.0625% bupivacaine with 2 mu/mL fentanyl or 0.125% bupivacaine with 2 mu/mL fentanyl. Data collected included length of stage II labor, incidence of operative or instrumental delivery rates, concentration of bupivacaine used, and demographic data. Demographics obtained included maternal age, weight, and height, as well as neonatal gestational age, weight, and Apgar scores. Further investigated were additional analgesic requirements of supplemental boluses of local anesthetic between the groups. No differences in demographics were noted between the groups. Instrumental delivery rates were similar between the groups with an incidence of 17.5% in the 0.125% bupivacaine group versus a 15% incidence in the 0.0625% bupivacaine group. Cesarean delivery rate was 17% in the 0.125% bupivacaine group versus a 21% ratio in the 0.0625% bupivacaine group. Duration of stage II labor was noted to be prolonged in the 0.125% bupivacaine group but was not statistically significant. Based on this data, it can be concluded that the use of 0.125% bupivacaine with 2 mu/mL fentanyl does not cause a statistically significant increase in instrumental or cesarean delivery rates, nor does it have a detrimental effect on length of stage II labor.

Adjuvants, Anesthesia↗

PubMed2006

Impacts of operative delivery for the first twin on neonatal outcomes in the second twin.

We assess the impacts of operative delivery for the first twins with vertex presentation on neonatal outcomes in second twins using the 1995 to 1997 twin registry data of the United States. A total of 102,554 eligible twin pairs with vertex presentation for the first twin were included in the analysis. Of these, 50,748 (49.5%) first twins had a normal vaginal delivery, 43,504 (42.4%) were delivered by cesarean section, and 8302 (8.1%) were delivered by vaginal operation (vacuum extraction or forceps). In term twins, the risks of asphyxia-related mortality (odds ratio [OR], 3.08; 95% CI, 1.07 to 8.45), newborn injury (OR, 2.10; 95% 1.39 to 3.12), low Apgar score at 5 minutes (OR, 1.49; 95% 1.24 to 1.78), and mechanical ventilation use (OR, 1.34; 95% 1.20 to 1.51) were increased in the second twins whose co-twins were delivered by vaginal operation compared with those whose co-twins who had normal vaginal delivery. In contrast, the risks of asphyxia-related mortality (OR, 0.55; 95% 0.17 to 1.57), newborn injury (OR, 0.20; 95% 0.11 to 0.34), low Apgar score at 5 minutes (OR, 0.51; 95% 0.44 to 0.60), and mechanical ventilation use (OR, 0.77; 95% 0.71 to 0.83) were decreased in the second twins whose co-twins were delivered by cesarean section compared with those whose co-twins had a normal vaginal delivery. In conclusion, vaginal operative delivery for the first twins is related to the adverse neonatal outcomes of their co-twins, whereas cesarean delivery for the first twins is associated with the beneficial neonatal outcomes of their co-twins.

Apgar Score↗