[TECHNIQUE OF DIRECTED LABOR WITH THIOBARBITAL ANALGESIA AND THE VACUUM EXTRACTOR. DOCUMENTAL FILM].
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Analgesia↗
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Results for “Vacuum Extraction, Obstetrical”
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[Urinary incontinence and pregnancy, vaginal childbirth and obstetric interventions].
The aim was to examine the association between pregnancy, vaginal childbirth (VC) and obstetric techniques, and the prevalence of urinary incontinence (UI). A cross-sectional survey enrolled a random population sample of 6240 women aged 20-59 years, who were mailed a self-administered questionnaire on UI and, among other things, experience of VC and obstetric intervention. More than 75% responded. The present analysis includes 4345 women. Multivariate UI prevalence odds ratios were increased in relation to UI during pregnancy, UI following immediately after a VC, and age 30 or more at the second VC. No multivariate association was found in relation to forceps delivery or vacuum extraction delivery, episiotomy or perineal suturing. In conclusions, not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent UI. Perineal suturing may be associated with prevalent UI, whereas other obstetric techniques inspected do not seem to be so.
Adult↗
[Medical interruption of pregnancy in India (author's transl)].
The law on medical interruption of pregnancy was introduced in India in 1971. According to this, a pregnancy may be interrupted (only by a specialist) if the life or mental health of the mother is threatened or if there is a danger of severe bodily or mental abnormality in the child. The methods of interruption used are: 1. simple suction, 2. dilatation and curettage (one or two sessions), 3. vacuum aspiration, 4. hysterotomy (abdominal, vaginal), 5. intrauterine injections (hypertonic saline or glucose solution, urea, prostaglandins), 6. intrauterine bougie. After the operation the doctor must advice the patient on methods of contraception.
Abortion, Legal↗
[The older primipara--an obstetrical risk group?].
While the number of the "elderly primigravida" seems to increase in some perinatal centers, we compared pregnancy, delivery mode and fetal outcome of 416 patients with a matched pair group of 15 year younger primigravida. While the rate of caesarean section and vacuum extraction rises up to 40%, we could not found any difference for the fetal outcome. Though we conclude that modern perinatal management in case of the elderly primigravida is very effective and allows normal fetal outcome.
Adult↗
Neurology and behaviour of newborn infants delivered by vacuum extraction on maternal indication.
23 full-term neonates delivered by vacuum extraction (VE) on maternal indication (primary or secondary uterine inertia) but with no sign of fetal asphyxia and a control group of 16 infants were studied. The infants were examined on the 1st and 5th days after birth with the Brazelton Neonatal Behavioural Assessment Scale and by a standardized neurological examination. On day 1 the VE-infants showed lower visual and auditory responsiveness in the behavioural assessment, and fewer optimal responses in the neurological examination than did the controls. Obstetrical factors such as abnormal presentation, long duration of the second stage of labour, and long duration of VE (greater than or equal to 15 minutes) may explain the differences. The differences between the groups had largely disappeared by day 5.
Child Behavior↗
[Advantages and disadvantages of deliveries after induction of labour by convenience (author's transl)].
The development of 601 deliveries after induction of labour by convenience, 92 births after induced labour following pregnancies at risk and 1829 births after spontaneous onset of labour were examined and compared. The data were recorded retrospectively and submitted to an electronic data processing. Patients with whom the labour was induced had the shortest birth times, the difference amounted on average to 2 hours. In the comparison collective with spontaneous setting in of labour a hypotonic uterus motility was found to be the most frequent pathological labour activity. Pathological pattern of heart frequency, especially late decelerations were most frequently registered with fetuses of the risk group. The frequency of the operative deliveries amounted to 13% in the case of the collective of the induced labour, 35,9% in the case of patients in the risk group, and 10% in the case of the comparison collective. Threatening fetal asphyxia and protracted extrusion period were in the case of primiparas after induced labour equally often the indication for a vaginal-operative delivery, whereas with the comparison collective, in the risk group and also with multiparas after induced labour, the threatening fetal asphyxia was primarily for the carrying out of a forceps delivery or a vacuum extraction. Concerning the birth weight and size the new-borns of the collectives examined showed no significant differences. The best Apgar-score was achieved by the new-born induced labour babies. Only 0,5% of these babies showed pronounced signs of placental dysfunction, in the risk group 9,6%, and in the comparison collective 1,6% of the babies were born with a pronounced Clifford-syndrome. Induced labour babies did not need any pediatric treatment. There were no perinatal deaths. In the case of comparison collective, long term pediatric treatment was necessary for 8 babies, 1 baby died subpartual, another one in the pediatric clinic, that means a perinatal mortality of 0,1%. In the risk group 3 babies needed pediatric treatment, 1 baby died of the consequences of a serious erythroblastosis, the perinatal mortality amounted to 1,1%. In a critical evaluation of the without exception favourable obstetrical results after induced labour, the technical, personal and organisational efforts should not be overlooked. This stands in the way of a widespread use of the process in the near future. The results hitherto permit the temporary inference that 1) psychologically positive prerequisites for the birth are created if the pregnant woman knows a firm date for the delivery, 2) the whole partus can be continuously supervised and the maternal and infantile emergencies prevented in good time and 3) through the calculability of risks during pregnancy and birth, perinatal mortality and morbidity can be reduced considerably.
Apgar Score↗
Early postpartum voiding dysfunction: incidence and correlation with obstetric parameters.
OBJECTIVE: To investigate the incidence and obstetric risk factors in early postpartum voiding dysfunction. STUDY DESIGN: Two hundred seventy-seven consecutive women in the early postpartum period were prospectively enrolled. Evaluation included history, physical examination, urinary questionnaire and non-invasive uroflowmetry measurements. Patients were interviewed regarding the presence and severity of voiding symptoms and were categorized into symptomatic versus asymptomatic subgroups. Obstetric parameters were compared in symptomatic versus asymptomatic patients as well as in cases of decreased (< 15 mL/sec) versus normal maximum urinary flow rates. RESULTS: One hundred twenty-five women (45% of the study population) hadearly postpartum voiding difficulties. Symptoms were significantly more common after vacuum extraction (38%) than spontaneous vaginal delivery (27%) or cesarean section (15%). The second stage of labor was significantly prolonged in symptomatic versus asymptomatic patients (62+/-52 versus 47+/-48 minutes). Voided volume, maximum and average flow rates and continuous flow pattern were significantly decreased in symptomatic versus asymptomatic patients. Twenty-eight patients (10%) demonstrated decreased (<15 mL/sec) maximum flow rates. The first stage of labor was significantly prolonged in these patients (9.7+/-5.8 versus 6.4+/-3.9 hours). Twenty-five patients (13%) gave birth to a neonate weighing > or =3,800 g. Maximum flow rates among these women were significantly decreased as compared to women with smaller infants (25.6+/-11 versus 32.9+/-19.2 mL/sec, respectively). CONCLUSION: Approximately 50% of patients complained of voiding difficulties in the immediate postpartum period. Main risk factors were prolonged first and second stages of labor, vacuum extraction and birth weight > or = 3,800 g. Long-term follow-up is needed to determine the significance of this clinically common entity.
Adult↗
Factors associated with success or failure in trials of vacuum extraction.
Failure rates for vacuum extraction of between one in 16 and one in 600 have been reported. Most studies report that unexpected failure carries a greater risk to both mother and fetus. The aim of this study was to determine factors that were likely to predict success or failure in trials of vacuum extraction. At the Port Moresby General Hospital, 59 trials of vacuum extraction were performed between 1 December 1997 and 30 November 1999. These cases were analysed according to whether vacuum extraction was achieved with more than or less than three pulls, or an alternative method of delivery was required to effect delivery Factors that were predictive of failure were: (i) Highlands origin of the mother; (ii) longer duration of the second stage of labour; (iii) severe moulding of the fetal head; (iv) cup detachments and deflexing cup applications; and (v) operator persisting with the procedure after three pulls. The cervix being less than fully dilated when the trial was commenced was not associated with a higher risk of failure, nor was it associated with a significantly higher risk of cervical trauma. Perinatal death and serious fetal scalp trauma were associated with deflexing cup applications, making more than three pulls and failed vacuum extractions.
Adult↗
[Experience obtained from segmental epidural analgesia in obstetrics (author's transl)].
Lumbar epidural anaesthesia was applied for obstetric analgesia to 103 women, most of them primiparae. Three different concentrations of Bupivacain (Markaine) were used for local anaesthesia, percentages being 0.5, 0.375, and 0.25. Effects and side-effects were evaluated. -- The rate of vacuum extraction was slightly increased under epidural analgesia (24.3 per cent), with ejection periods being enlarged to average values between 82 and 63 minutes. Frequency of caesarean sections as well as both the acid-base status and Apgar scores of the newborns were similar to those recordable from comparison groups. -- Advantages were clearly visible and side-effects of minor importance. Catheterisation for lumbar epidural anaesthesia, consequently, is recommended as an optional approach to obstetric analgesia.
Acid-Base Equilibrium↗
Episiotomy, operative vaginal delivery, and significant perinatal trauma in nulliparous women.
OBJECTIVES: The aim of this study was to determine whether choice of obstetric instrument at operative vaginal delivery is associated with any differences in the rate of significant perineal trauma and whether this rate is modified by the use of episiotomy. STUDY DESIGN: The occurrence of significant perineal trauma among 323 consecutive operative vaginal deliveries was evaluated according to type of instrument used and performance of episiotomy. These findings were compared with spontaneous vaginal deliveries during the same period. RESULTS: Among forceps deliveries the use of episiotomy was not associated with a difference in the occurrence of significant perineal trauma (55% vs 46%; relative risk, 1.2; 95% confidence interval, 0.8-1.9). Among vacuum extraction deliveries an increased rate of such trauma was noted when episiotomy was used (34.9% vs 9. 4%; relative risk, 3.7; 95% confidence interval, 1.2-11.2). There was no difference in the rate of significant perineal trauma according to type of forceps used. In a logistic regression analysis forceps delivery with or without episiotomy was associated with an increase of >10-fold in the rate of significant perineal trauma with respect to vacuum extraction deliveries without episiotomy. CONCLUSIONS: Our data suggest that in forceps delivery neither the type of forceps nor episiotomy influences the risk of significant perineal trauma. When vacuum extraction delivery is performed, the use of episiotomy is associated with a higher risk of significant perineal trauma.
Adult↗
[Fetal extraction by vacuum].
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Delivery, Obstetric↗
[Vacuum extractor in modern obstetrics].
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Extraction, Obstetrical↗
Rates for obstetric intervention among private and public patients in Australia: population based descriptive study.
OBJECTIVE: To compare the risk profile of women receiving public and private obstetric care and to compare the rates of obstetric intervention among women at low risk in these groups. DESIGN: Population based descriptive study. SETTING: New South Wales, Australia. SUBJECTS: All 171,157 women having a live baby during 1996 and 1997. INTERVENTIONS: Epidural, augmentation or induction of labour, episiotomy, and births by forceps, vacuum, or caesarean section. MAIN OUTCOME MEASURES: Risk profile of public and private patients, intervention rates, and the accumulation of interventions by both patient and hospital classification (public or private). RESULTS: Overall, the frequency of women classified as low risk was similar (48%) among those choosing private obstetric care and those receiving standard care in a public hospital. Among low risk women, rates of obstetric intervention were highest in private patients in private hospitals, lowest in public patients, and generally intermediate for private patients in public hospitals. Among primiparas at low risk, 34% of private patients in private hospitals had a forceps or vacuum delivery compared with 17% of public patients. For multiparas the rates were 8% and 3% respectively. Private patients were significantly more likely to have interventions before birth (epidural, induction or augmentation) but this alone did not account for the increased interventions at birth, particularly the high rates of instrumental births. CONCLUSIONS: Public patients have a lower chance of an instrumental delivery. Women should have equal access to quality maternity services, but information on the outcomes associated with the various models of care may influence their choices.
Cesarean Section↗
[Pre-eclampsia and anesthesia].
The management of anaesthesia in patients suffering preeclampsia has to be selected individually. There is a high rate of caesarean sections in patients with preeclampsia. Intubation anaesthesia or regional anaesthesia are commonly used methods and can be considered comparable and equally useful. In our opinion, the application of regional anaesthesia should be preferred, if the initial criteria, such as normal neurologic status and blood coagulation, are fulfilled. We believe in a considerable reduction of vital risks when using regional anaesthesia. Our aim was to figure out the risk-factors of preeclampsia and preterm maturity regarding anaesthesia management. Preeclampsia is a severe illness in pregnancy with a frequency of 5-10%. In 1997, we experienced 73 patients with praeeclampsia according to the definition of ISSPH. Mode of delivery was conventional in 10 patients, 2 patients had a vacuum extraction and 61 patients needed a caesarean section. The rate of epidural anesthesia for delivery was 51%. We used epidural anaesthesia in 6 spontaneous deliveries, in 2 vacuum extractions and in 30 caesarean sections. There were no problems with epidural anaesthesia and the outcome of mother and child was also considered to be excellent. We suggest to use regional anesthesia techniques whenever possible.
Anesthesia, Conduction↗
The beneficial effect of vacuum extraction of the fetus.
The vacuum extractor (VE) was applied electively after approximately 25 min of expulsion in 25 normal primiparae. Twenty-five identical parturients with spontaneous deliveries served as controls. The fetal scalp pH was measured at the beginning of the 2nd stage, and again in the cord blood of all newborns. Cardiac monitoring by scalp electrode was done for all fetuses throughout labor. The mean pH of the first blood sample was almost identical in the two groups, while the mean decrease in pH in the VE group was 0.077, against a mean change of 0.106 in the controls (p less than 0.05). In the FHR graph the total area of deceleration, and separately in the controls (p less than 0.05). In the FHR graph the total area of deceleration, and separately the up to 30 beats/min (area A) and of more than 30 beats/min (area B) were calculated. The mean total area of deceleration in the VE group was 14.76 cm2vis-à-vis 17.56 cm2 in the controls. Areas A and B were also smaller in the study group, but these differences were not statistically significant. The mean total deceleration time in the VE fetuses was 22.8 min, and 37.75 min in the controls (p less than 0.001). It is concluded that the application of the VE during the second stage lessens fetal depression, when compared with spontaneous delivery.
Extraction, Obstetrical↗
Factors associated with fear of delivery in second pregnancies.
OBJECTIVE: To identify factors associated with fear of childbirth during and after first labor. METHODS: We analyzed first deliveries of 100 primiparas who reported severe fear of vaginal childbirth during their second pregnancies and 200 age- and parity-matched controls who reported no later fear of delivery. The main outcome measures were previous miscarriages, participation in birth-education classes, support during labor, length of first delivery, pain relief, obstetric complications, welfare of the newborn, and time between deliveries. RESULTS: The prevalence of emergency cesarean (adjusted odds ratio [OR] 26.9, confidence interval [CI] 11.9, 61.1) and vacuum extraction (adjusted OR 4.5, CI 2.2, 9.3) during first delivery was much higher in subjects than controls. Labor lasted longer in cases than in controls during the first (10.5 hours versus 7.8 hours, P = .016) and second stages (62 minutes versus 47 minutes, P = .002). They received epidural analgesia more often, but its timing and the amount used were not different between groups. Of the group with fear, 44% could not define any specific cause for fear and regarded the entire delivery as frightening. CONCLUSION: Emergency cesarean and vacuum extraction during first deliveries were associated with secondary fear of delivery. Emergency obstetric procedures cannot be avoided, so prevention of fear might require more education on causes and consequences of cesarean or vacuum extraction, eg, in birth classes and at postpartum visits.
Adult↗
Faecal incontinence after childbirth.
OBJECTIVE: To measure the prevalence and severity of postpartum faecal incontinence, especially new incontinence, and to identify obstetric risk factors. DESIGN: A cohort study with information on symptoms collected in home-based interviews and obstetric data from hospital casenotes. SETTING: Deliveries from a maternity hospital in Birmingham. PARTICIPANTS: Nine hundred and six women interviewed a mean of 10 months after delivery. MAIN OUTCOME MEASURES: New faecal incontinence starting after the birth, including frank incontinence, soiling and urgency. RESULTS: Thirty-six women (4%) developed new faecal incontinence after the index birth, 22 of whom had unresolved symptoms. Twenty-seven had symptoms several times a week, yet only five consulted a doctor. Among vaginal deliveries, forceps and vacuum extraction were the only independent risk factors: 12 (33%) of those with new incontinence had an instrumental delivery compared with 114 (14%) of the 847 women who had never had faecal incontinence. Six of those with incontinence had an emergency caesarean section but none became incontinent after elective sections. CONCLUSIONS: Faecal incontinence as an immediate consequence of childbirth is more common than previously realised, and medical attention is rarely sought. Forceps and vacuum extraction deliveries are risk factors, with no protection demonstrated from emergency caesarean section. Identification and treatment is a priority.
Adult↗
Influence of spontaneous and instrumental vaginal delivery on objective measures of pelvic organ support: assessment with the pelvic organ prolapse quantification (POPQ) technique and functional cine magnetic resonance imaging.
OBJECTIVE: To determine the influence of spontaneous and instrumented vaginal delivery on objective measures of pelvic organ support. STUDY DESIGN: Prospective study at a university hospital with two study groups: vaginal spontaneous delivery (n = 26) and vacuum extraction (n = 49). Control group consisted of healthy nulliparous volunteers (n = 20). Participants underwent pelvic organ support evaluation by use of the pelvic organ prolapse quantification (POPQ) examination and postpartum functional cine magnetic resonance imaging (MRI). RESULTS: Significant differences for individual POPQ component measurements were noted for points Aa and Ba, TVL, and GH (spontaneous delivery versus control) and in addition for Ap, Bp, and D (vacuum extraction versus control). Significant differences for MRI measurements were observed for the position of bladder base, bladder neck, posterior fornix of the vagina, anorectal junction, hiatus perimeter and depth of rectocele. CONCLUSIONS: Considerable changes in pelvic organ support after vaginal delivery can be demonstrated by a reproducible and reliable clinical classification system (POPQ) and by functional cine magnetic resonance imaging.
Adult↗