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A comparison of metal and plastic cannulae for vacuum aspiration.

A comparative study of the safety and effectiveness of metal (Purandare) versus plastic (Karman) cannulae for first trimester abortion was conducted on 400 women. Two hundred vacuum aspiration procedures were performed using each type of cannula. All aspirations were performed by a single physician, and patient follow-up was performed by a second physician. The complication rates, amount of retained tissue, rates of cannula obstruction and procedure times of the two cannulae were compared. Our findings showed no significant difference in any of these evaluation criteria for the metal and plastic cannulae.

Abortion, Therapeutic↗

Segmental epidural analgesia in labour: related to the progress of labour, fetal malposition and instrumental delivery.

The effect of low-dose continuous segmental epidural analgesia given during the first stage of labour on the progress of labour, the frequency of fetal malpositions and the rate of vacuum extractions was studied prospectively in 100 parturients (epidural group). The results were compared with 100 parturients given none or conventional analgesia (control group). The results showed that in the primiparous epidural group the progress of labour before analgesia was induced was significantly slower than in the control group. After the block, however, the subsequent course of the labour was of equal duration in both groups. The durations of the second stages of labour did not differ significantly between the groups. The differences in fetal malpositions at delivery were statistically insignificant. Nor did the rate of vacuum extractions, 8% in the primiparous and 0% in the multiparous epidural group, differ statistically from the corresponding rate in the control groups. The results signify a normal progress and outcome of labour after low-dose segmental epidural analgesia.

Adolescent↗

Maternal and neonatal morbidity in instrumental deliveries with the Kobayashi vacuum extractor and low forceps.

Risks to the mother and newborn associated with the use of the Kobayashi Silastic vacuum extractor (n = 293) were compared with those associated with the use of low forceps (n = 468) in a retrospective chart review. Third or fourth degree perineal tears and vaginal and cervical lacerations were all observed less frequently among women delivered with the vacuum extractor. The need for post-partum bladder catheterization was also reduced for these women. Babies born by the means of the vacuum extractor ran an increased risk of cephalhematoma and neonatal jaundice. No difference in major neonatal morbidity was observed between the two groups. The Kobayashi instrument appears to be a useful alternative to forceps in low vaginal instrumental deliveries.

Birth Injuries↗

Cohort study of silastic obstetric vacuum cup deliveries: I. Safety of the instrument.

A prospective study was undertaken to determine the safety of the Silastic vacuum extractor. Between November 1982 and July 1983, a cohort of 84 successful vacuum extractor deliveries was examined, using the next sequential forceps delivery and spontaneous vaginal delivery as controls. In addition to routine neonatal morbidity measures, Scanlon early neonatal neurobehavioral scale and a modified Sarnat encephalopathy staging examination were used to critically assess neurologic functioning; a cranial ultrasound scan was performed to look for intracerebral hemorrhage, and an indirect ophthalmologic examination was done to assess the incidence of retinal hemorrhage. The study yielded no significant increase in maternal vaginal trauma for vacuum extractor versus spontaneous vaginal delivery, but there was a significantly greater incidence for forceps delivery (60%) versus vacuum extractor (25%) and more associated blood loss for forceps delivery (P less than .01). There was no significant increase in neonatal morbidity for vacuum extractor compared with forceps delivery nor in serious morbidity compared with spontaneous vaginal delivery. Specifically, for vacuum extractor versus forceps delivery there was no difference in one- and five-minute Apgar scores, extent of resuscitation, cosmetic injury, jaundice, mean neonatal intensive care unit stay, or incidence of retinal hemorrhage. Notably, there was no mortality related to delivery method, but there were two unrelated deaths. There were no cases of intraventricular or subgaleal hemorrhage on clinical or ultrasound examination, but one stillborn infant, who succumbed to a generalized coagulation defect, had a subarachnoid hemorrhage. Finally, there was no significant difference in Sarnat encephalopathy staging or Scanlon neurobehavioral assessment between spontaneous vaginal, forceps, and vacuum extractor deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗

[Psychomotor development of children born operatively by Caesarian section, vacuum or forceps in the period between 3 and 7 years (author's transl)].

In the period between 1966 and 1977 9,591 children were born at the UFK, Mannheim, and of these 1.008 were operative deliveries (10.5%). Out of these children, 99 of those delivered by section, 39 by forceps, 140 by vacuum and 67 spontaneous births were examined in an alphabetically determined group (R) for mental and motor development. The means used for the follow-up investigation were the Kramer-Binet Intelligence Test, and careful questioning of the parents on their children's early development. No connection between the type of delivery and intelligence quotient could be determined. A mean IQ of 114.4 was found for those delivered by section, 116.6 for those by forceps, and 117.7 for thos delivered by vacuum. The spontaneously-born children had an IQ of 108.7. The IQ results determined were correlated with the following data: EPH-gestosis, alteration in the child's heart sounds, protracted birth and Apga. No significant differences in the intelligence or any delayed motor development could be found in relation to the comparative group.

Adult↗

Alpha-fetoprotein concentration in maternal serum and abortion via VA and PGF2alpha.

Most women undergoing abortion by vacuum aspiration (VA), extraamniotic prostaglandin instillation or vaginal prostaglandin suppositories showed a significant rise in their serum alpha-fetoprotein (AFP) concentrations during the procedure. We suggest this rise is due to a fetomaternal hemorrhage during the abortion procedure. Few women undergoing VA before 9 weeks' gestation showed this rise in serum AFP. To avoid fetomaternal hemorrhage during pregnancy termination, we recommend abortion by VA in early pregnancy.

Abortion, Therapeutic↗

Sphincter rupture and anal incontinence after first vaginal delivery.

BACKGROUND: The aim of this prospective study was to establish the incidence of anal incontinence and sphincter defects after first vaginal delivery. METHODS: A total of 99 nulliparous and pregnant women were examined prospectively 4 weeks (mean) before delivery and 4 months (mean) after delivery. Of the study population, 75 (76%) women had vaginal delivery and 24 (24%) had cesarean section. Vacuum extraction was necessary in 20 (20%) cases. The symptoms of anal incontinence were asked about using a standard questionnaire. Clinical examination, endoanal ultrasound (EAUS) and anal manometry were performed before and after delivery. RESULTS: The symptoms of mild anal incontinence, mainly gas incontinence, increased after vaginal delivery more than after cesarean section (P < 0.032). Occult anal sphincter defects were noted in 17 (23%) of the 75 women after vaginal delivery by using EAUS. After vacuum extraction, anal sphincter defects were noted in nine (45%) out of 20 women. No new sphincter defects were found in the cesarean section group. The maximal squeezing pressures were significantly decreased in the patients with external anal sphincter (EAS) defects (P = 0.0025). Vacuum extraction leads to more sphincter defects but does not significantly increase anal incontinence or decrease mean anal sphincter pressures. CONCLUSIONS: The first vaginal delivery can result in occult sphincter defects and the use of vacuum extraction increases the risk.

Adult↗

Use of the soft, silicone obstetric vacuum cup for delivery of the fetal head at cesarean section.

Delivery of the fetal head at cesarean section can sometimes be very difficult, and serious maternal and fetal complications may occur. Recently a new soft, silicone obstetric vacuum cup was introduced for use on the fetal head at vaginal delivery. In 35 cases the cup was used for delivery of the fetal head at cesarean section. It is an effective, harmless alternative to conventional devices, especially in aiding the delivery of the high-floating head occurring spontaneously or occurring after the head impacted deep in the pelvis is dislodged.

Cesarean Section↗

[Clavicle fracture in the newborn].

The authors have found 244 clavicle fractures during 4131 vaginal delivery (5.91%). Both clavicles of three newborns have fractured. The incidence of fracture had relation to weight of newborns, to weakness of pains and to vacuum extraction. The Apgar score of the newborns with fractured clavicle was not less, than one of newborns with unbroken clavicle. None of 704 newborns from cesarean section, and none of 52 newborns, who was born out of the hospital had fracture of the clavicle. The cause of fracture is the violent hurry of delivery, the drawing of the head before birth of shoulders. One of 244 injured newborns had permanent brachial plexus palsy. Late complication was not found. Between the injured newborns was more frequent the jaundice requiring phototherapy.

Apgar Score↗

Vacuum extraction: a randomized controlled comparison of the New Generation cup with the original Bird cup.

A new design of vacuum extractor cup--'the New Generation cup'--has recently been introduced into clinical practice. Its major modification is a traction cord which passes around the rim of the cup for 180 degrees and is free to slide within the rim. Claims that this design 'enables the operator to pull obliquely without causing the cup to tilt' and thereby 'reduces failure rates, reduces the incidence of scalp trauma and increases operator confidence' have been evaluated in a randomized controlled trial. 123 women with singleton pregnancies of 37 completed weeks or more, with a cephalic presentation and for whom a decision to deliver by vacuum extraction had been taken, were randomly allocated to the 'New Generation' cup or BIRD's original vacuum extractor cup; 50 mm anterior and posterior cups were used in both groups as appropriate. The two groups were comparable at entry and delivered by obstetricians of similar status. The two types of cup were similar in respect of number of failures to deliver with the vacuum extractor, correct positioning of the cup, number of pulls required for delivery and time taken to expedite delivery. Cup detachments occurred in nine cases allocated to the 'New Generation' cup compared with four allocated to the original BIRD cup. The babies in the two groups were in similar condition at birth and sustained similar amounts of scalp trauma. Neonatal jaundice, both clinical and biochemical, was more common in babies delivered with the 'New Generation cup' and this was reflected in greater use of phototherapy in this group. Operators were equally divided in their preference of cup.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Clinical assessment of the pelvic cavity and outlet.

A clinical assessment of the pelvic midplane (or cavity) and the pelvic outlet was made in 1,286 singleton pregnancies with a cephalic presentation of the fetus. 43 cases (3.4%) of pelvic contraction were excluded. The mothers were divided into two groups: those with an adequate pelvis and those with a borderline pelvis (18.6%). Those with a borderline pelvis were further subdivided into three categories: those with a borderline outlet, those with a borderline midplane and those with a borderline midplane and outlet. With a funnel pelvis the incidence of occiput posterior positions and vacuum extractions was three times as high and the duration of the first and the second stages of labor slightly longer when compared with those who had a normal pelvis. A borderline midplane seemed least harmful type with lower incidences of caesarean section and vacuum extraction, and a first stage of normal duration. Although birthweight had an effect on the duration of the first stage of labor in women with an ample pelvis, this was not the case with a borderline pelvis. The assessment of fetal weight therefore seems unnecessary in with a borderline midplane or outlet. With a borderline midpelvis and outlet the course of labor seemed normal in most cases. Clinical assessment of the midpelvis and the pelvic outlet seems to be the best method of measuring pelvic capacity.

Adolescent↗

Occult anal sphincter trauma following randomized forceps and vacuum delivery.

OBJECTIVE: To determine the prevalence of occult anal sphincter trauma 5 years after randomization to forceps and vacuum delivery. METHOD: Anal endosonography and manometry was performed in 44 of 313 women who had originally participated in one center of the Keele University Multicenter Assisted Delivery Trial at the North Staffordshire Maternity Hospital between September 1989 and May 1990. RESULTS: 50% admitted to defecatory symptoms and anal sphincter defects were identified in 61%. On the basis of intention to treat, 82% of forceps (n = 17) and 48% of vacuum deliveries (n = 27) had occult sphincter defects (P = 0.03). In four women, both instruments were used. However, the preponderance of defects in the forceps group persisted even when analysis was performed according to the final mode of delivery as well as in the group where only one instrument was used (n = 40). There was a significant fall in maximum squeeze anal pressure in the forceps group compared to the vacuum group (56 vs. 36 mmHg; P = 0.0007). Although twice as many in the forceps group suffered anal incontinence (32% vs. 16%) significance was not reached. CONCLUSIONS: Vacuum delivery appears to be associated with less occult anal sphincter trauma than forceps delivery. A large prospective randomized study is required to address the impact of specific situations, such as failed instrumentation with use of a second instrument and rotational delivery.

Adult↗

Vacuum extraction and herpes simplex virus infection.

OBJECTIVE: To search for an association between delivery by vacuum extraction and an increased neonatal risk for herpes simplex virus (HSV) infection. METHODS: In a cross-sectional, descriptive, controlled study, the study (vacuum extraction) and control (spontaneous delivery) groups each included 50 consecutive women with no history of HSV infection. Cultures for HSV were obtained from the genital tracts of all parturient women and the scalps of their newborns. RESULTS: Following operative vaginal delivery, two newborns (4%) had scalp vesicles and cultures were positive for HSV for both mothers and newborns; two newborns (4%) had scalp vesicles and cultures were negative for HSV; and two newborns (4%) without scalp vesicles had cultures positive for HSV. Following spontaneous delivery, cultures were positive for HSV for four women and their newborns (8%). CONCLUSION: Herpes simplex virus isolated from the scalps of newborns may often result from colonization rather than infection.

Adult↗

Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication.

A case of growing skull fracture following birth trauma and caused by vacuum extraction is reported in order to emphasize the incidence of this peculiar head injury at the beginning of extrauterine life and to point out its relation to possible neuropsychological disturbances that may appear later in childhood. Delivery by vacuum extraction increases the incidence of perinatal injuries and consequently the incidence of neurological deficits in children. Neurosurgical repair is advocated as the appropriate treatment, with the aim not only of cosmetically correcting the lesion's typical subgaleal protuberance with cranioplasty, but also of performing a water-tight closure of the dura, enabling the cerebral cortex to "fill in" the intracerebral lesion. The surgical technique and gross pathology of the lesion are described together with radiological findings before and after surgery. Reports by other authors are reviewed in an attempt to identify the conditioning factors and pathological features of this traumatic injury to skull and brain in neonates and infants. The literature on cranial fractures associated with intracerebral lesions at this age shows a significant difference in recovery and outcome from that after similar lesions in older children.

Female↗