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PubMed1991

[A fetal extraction device used in under-equipped countries: the obstetrical vacuum extractor. Results of 393 vacuum extractions in the Maternity Hospital in Sélestat. (Reflections on the use of this device in African practice)].

The level of mortality and feto-maternal morbidity in under-equipped countries is frightening. It is important to find answers. Among these: the obstetrical Ventouse is an instrument that can be used for extracting the fetus without too much difficulty. It is relatively easy to learn and to apply as compared with forceps (so long as the mechanism by which it is used is understood). The conditions under which it can be used are well defined at present: term pregnancy, the woman must be in labour, fetal membranes must be ruptured, the cervix must be completely dilated, presentation must be cephalic and the head must be engaged. 393 Ventouse extractions were carried out between 1982 and 1988 at the Maternity Hospital of Selastat and this resulted in delivery of 393 infants in good health. No maternal or fetal mortality occurred in the series. The maternal morbidity was low at 0.76% and the fetal morbidity was only 4.7%. In view of our experience, we believe that the tendency for black women to have android pelves makes it preferable to use the Ventouse as against the forceps because it has several advantages. In view of the literature and of their practice, the authors advise that the obstetric Ventouse should be used in under-equipped countries where conditions of practice are often precarious and the team poorly qualified. This will reduce the mortality and morbidity due to delivery. Pregnant women are insufficiently educated. The quality of health personnel is inadequate. The health services are inadequate for the needs of the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Perinatal audit of one hundred consecutive vacuum extractions in Maputo.

The extraordinary demands on obstetrical services that prevail in many developing countries necessitate critical reviews of existing norms for obstetrical management. Vacuum extractions were studied in this context as a part of the regular perinatal audit carried out at the Maputo Central Hospital, the only hospital in Maputo with emergency surgery catering to the 43,000 annual deliveries. Extractions performed with the fetal head above the ischiatic spines were associated with a high number of complications and an 81% risk of neonatal asphyxia and also with a number of severe neonatal traumas. The risk of intracranial hemorrhage tended to be higher with extractions of fetuses with the head at or above the ischiatic spines, particularly when there was concomitant intrapartum asphyxia. It is concluded that a frequent perinatal audit of selected risk deliveries is a useful monitoring tool for examining prevailing indications for various obstetric interventions.

Asphyxia Neonatorum↗
PubMed1986

Cohort study of Silastic obstetric vacuum cup deliveries: II. Unsuccessful vacuum extraction.

In a cohort analysis of Silastic vacuum extractor deliveries, 65% were completed with the vacuum extractor alone, 24% with outlet forceps, 3% with midforceps, and 7% with cesarean section (vacuum extractor-cesarean). Control groups were formed by using the next sequential forceps delivery, spontaneous vaginal delivery, and every second cesarean section after a trial of labor. The infants were examined using a neurobehavioral scale, an encephalopathy assessment, cranial ultrasound, and indirect ophthalmoscopy. In the combined vacuum extractor and forceps delivery subgroup (vacuum extractor-forceps), all but 3% were converted from a high mid-forceps delivery to outlet forceps by the initial vacuum extractor procedure, thus eliminating many difficult midforceps deliveries. The study yielded no significant difference in maternal morbidity between vacuum extractor-forceps and forceps delivery, no difference in vaginal trauma for vacuum extractor-cesarean versus vacuum extractor delivery, and no greater hospital stay, infection rate, or need for transfusion for either vacuum extractor-forceps versus forceps delivery or vacuum extractor-cesarean versus cesarean delivery. Neonatal morbidity did not differ between successful and unsuccessful trial of vacuum extractor, except for an increased frequency of retinal hemorrhage. The frequency of scalp trauma, including cephalohematoma, did not differ between vacuum extractor-forceps and forceps delivery, or between vacuum extractor-cesarean and vacuum extractor delivery. For vacuum extractor-forceps versus forceps delivery and vacuum extractor-cesarean versus cesarean section, there were no significant differences in neurobehavioral or encephalopathy scores, or in the frequency of neonatal jaundice, facial palsy, anemia, fractures, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Cesarean Section↗