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PubMed1990

Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries.

Third- and fourth-degree perineal lacerations occur frequently during operative vaginal deliveries. To identify risk factors for lacerations, 2832 consecutive forceps and vacuum extraction deliveries were analyzed. Third- and fourth-degree lacerations occurred in 30% of deliveries. Multiple logistic regression was used to control for intercorrelation between potential risk factors. Factors associated with increased risk for third- and fourth-degree lacerations were midline episiotomy, nulliparity, second-stage arrest, occipitoposterior position, low or mid station, use of forceps instead of vacuum, use of local anesthesia, and Asian race. When these factors were controlled, there was no effect of birth weight, faculty versus resident operator, gestational age, abnormalities of first-stage labor, or several other factors. Prevention of perineal lacerations requires that the operator identify the patient at risk. Possible options for management of high-risk patients include use of mediolateral episiotomy or no episiotomy, use of vacuum extraction instead of forceps, and use of conduction anesthesia.

Anesthesia, Obstetrical↗
PubMed1992

Instrumental rotational delivery in primiparae.

We analysed 98 consecutive instrumental rotational deliveries of babies weighing > 2,500 grams in primiparae. Our aim was to compare the use of Kjelland's forceps with vacuum delivery with regard to efficacy and safety. The vaginal delivery rate was similar with Kjelland's forceps (96%) and vacuum (90%). The vacuum cup failed to effect rotation in 14% and 77% required forceps delivery after vacuum rotation. The vacuum took longer to effect delivery (P < 0.01). Women delivered with Kjelland's forceps had higher pain scores in the puerperium. There were no perinatal deaths. Low Apgar scores and cord arterial pH values of less than 7.20 were recorded more frequently after vacuum rotation (p < 0.05). Babies delivered with Kjelland's forceps sustained more physical trauma. The incidence of asphyxial encephalopathy was the same in both groups. We would recommend a more selective approach to the use of both rotational vacuum and Kjelland's forceps in primiparae.

Adult↗
PubMed1985

Midtrimester abortion with Laminaria and vacuum evacuation on a teaching service.

Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health-care providers; many authorities insist that this procedure should be performed only by a small group of experts. Our institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with Laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. Twelve resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1,392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979, and December 31, 1980, were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major complications that necessitated laparotomy. Despite the use of Laminaria overnight, a "no-touch" rather than full sterile technique and no prophylactic antibiotics, infectious complications were minimal. We conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

Abortion, Induced↗
PubMed1981

Comparison of maternal and fetal effects of vacuum extraction with forceps or cesarean deliveries.

Results of 90 vacuum extraction (VE) deliveries were compared with effects on the mother and fetus of forceps delivery or cesarean section. Forceps delivery increased the incidence of birth canal trauma threefold and the incidence of anemia sevenfold (18% for VE versus 48% for forceps delivery, and 4 versus 30%, respectively) (P less than or equal to .001). When cesarean section was the alternative operation, the incidence of blood loss was significantly increased (72%, versus 18% with VE), as was febrile morbidity (48%, versus 6% with VE) (P less than or equal to .001). Hospitalization time and costs in the present and future for cesarean section deliveries are markedly higher than for VE. Maternal requirements for anesthesia are markedly reduced with VE because of the gentleness of the operation. A failed trial of VE in 7 patients did not constitute any greater hazard to the mother than initial management by cesarean section. However, babies born by cesarean section after failed VE had a slightly lower Apgar score at 1 minute (P less than or equal to .05) but not at 5 minutes, as compared with babies born by cesarean section attempted initially. Otherwise, Apgar scores of infants born by VE did not differ from those of infants delivered by forceps or cesarean section. Infants delivered by VE had a higher incidence of transient cosmetic deformations, including "chignon" and cephalhematoma, whereas infants delivered by forceps had forceps marks and facial lacerations more frequently. Neither perinatal mortality nor serious traumatic complications were attributable to VE, due to its judicious use for a limited time of approximately 15 minutes.

Anesthesia, Obstetrical↗
PubMed1987

Neonatal retinal hemorrhages and neurobehavior related to tractive force in vacuum extraction.

Fifty clinically indicated vacuum extractions were studied to evaluate a possible relationship between neurobehavioral abnormality, retinal hemorrhages and the tractive force used for delivery. A Vacuum Extractor Recorder (Type SF 30, Knick), was used to measure the forces necessary for delivery of the head. Infants delivered by the use of extensive tractive force showed no greater incidence of neuropathology than those delivered with less tractive force. The retinal hemorrhages were equally distributed among the infants, irrespective of the tractive force applied or the neurobehavioral assessment. The implication is that retinal hemorrhages cannot be used to evaluate the extent of cerebral influence after birth and that the main cause of neurobehavioral abnormality is the condition leading to the use of the vacuum extractor (VE).

Adult↗
PubMed1990

New design rigid and soft vacuum extractor cups: a preliminary comparison of traction forces.

Women due for vacuum extraction were randomly allocated to delivery using one of two soft cups (Silc or Silastic) or two new design rigid cups (New Bird or O'Neil). Traction forces were recorded continuously and higher values were reached with the rigid than the soft cups (median 15.8, range 7.5-19.7 vs 11.1, 7.2-15.1 kg, P less than 0.01). Selection of the most appropriate vacuum cup for each clinical situation should take into account that the flexible cups are associated with less cosmetic disfigurement but have a lower capacity for traction.

Equipment Design↗
PubMed1986

Vacuum extraction at cesarean section--neonatal outcome.

The use of the vacuum extractor at cesarean section has been advocated in order to avoid extension of the uterine incision and to facilitate the delivery of a floating head. We have evaluated, prospectively and retrospectively, the neonatal outcome of vacuum extraction at cesarean section in comparison with regular cesarean section. The interval between the final uterine incision and complete delivery (U-D interval) was significantly prolonged (P less than 0.01) in 8 cases of vacuum extraction (Group A) when prospectively compared with 10 cases of regular cesarean section (Group B). The Apgar scores, the acid-base values at delivery and the clinical course of the two groups were not significantly different. Although analysis of our prospective data suggests a trend of an association between prolongation of the U-D interval and neonatal depression, our retrospective data of 34 neonates delivered by vacuum extraction at cesarean section and 44 neonates delivered by regular cesarean section, showed no significant untoward effect when the vacuum extractor was utilized. Since prolongation of the U-D interval may have an undesireable effect on the fetus, we advocate extra caution in the use of this method.

Apgar Score↗
PubMed1997

Stepwise compared with rapid application of vacuum in ventouse extraction procedures.

OBJECTIVE: To compare a one-step (rapid) application of negative pressure (vacuum) with conventional stepwise application for ventouse extraction following a prolonged second stage of labour. DESIGN: Randomised controlled study. SETTING: Teaching Hospital. PARTICIPANTS: Forty-seven women were randomised to the rapid vacuum group and 47 to the stepwise group. MAIN OUTCOME MEASURES: Duration of ventouse procedure, effectiveness of methods of application, morbidity of mother and infant. RESULTS: There was no significant difference in frequency of detachment of the cup after rapid or stepwise application of vacuum. A reduction in mean duration of the ventouse procedure of 6 min was realised without significant difference in maternal or neonatal morbidity. CONCLUSION: Rapid application of vacuum significantly reduces the duration of a ventouse extraction procedure without compromise to efficiency and safety.

Acid-Base Equilibrium↗