PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Vacuum Extraction, Obstetrical”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,297 records · Page 72Linked to original sources
PubMed2002

Low-volume obstetrics. Characteristics of family physicians' practices in Alberta.

OBJECTIVE: To compare the obstetric practices of family physicians who attended fewer than 25 births per year (low-volume) with the practices of family physicians who attended more than 25 births per year (high-volume) and the practices of obstetricians. DESIGN: Retrospective cohort study using data from administrative databases. SETTING: Alberta. PARTICIPANTS: All physicians who provided intrapartum care between April 1, 1997, and March 31, 2000. MAIN OUTCOME MEASURES: Type of delivery, size of hospitals where deliveries took place, characteristics of patients, and number of medical interventions. RESULTS: Of 1026 family physicians, 543 (53%) were low-volume providers of intrapartum care. In 1997-1998, low-volume family physicians (LVFPs) attended 24% of all vaginal and cesarean births attended by family physicians; by 1998-1999, that percentage had decreased to 9%; and by 1999-2000, to 5%. In contrast, the number of births attended by all family physicians remained relatively constant at 43% during the 3 years. In hospitals that had fewer than 50 deliveries a year, LVFPs attended almost half the births. Although LVFPs did fewer medical inductions, vacuum extractions, and epidural anesthetics and more forceps extractions, episiotomies, and cesarean sections than high-volume family physicians (HVFPs), the differences between their practices were much smaller than the differences between all family physicians' practices and the practices of obstetricians (who treat higher-risk mothers and newborns). CONCLUSION: The decrease in LVFPs' obstetric practices could make a pronounced difference at smaller hospitals where most low-volume practice occurs.

Alberta↗
PubMed2004

[Obstetrical brachial plexus palsy--etiopathogenesis, risk factors, prevention, prognosis].

Obstetrical brachial plexus palsy (OBP) complicates a small proportion of births. The incidence is believed to be 0.35 to 5 cases per 1000 live births. Risk factors of OBP included: 1/ large birth weight, 2/ shoulder dystocia and prolonged second stage of labour , 3/ instrumental vaginal delivery (forceps delivery, vacuum extraction), 4/ diabetes mellitus and mother's obesity, 5/ breech presentation, 6/ delivery an infant with OBP in an antecedent delivery. Historically, the cause of OBP was excessive lateral traction applied to the fetal head at delivery, in association with anterior shoulder dystocia. Not all cases of brachial plexus palsy are attributable to traction. Brachial plexus injury may be occurring in the absence of shoulder dystocia, in the posterior arm of infants with anterior shoulder dystocia and can be associated with cesarean delivery. Intrauterine factors may play some role in the etiology of the OBP. Many strategies have been proposed to prevent the occurrence of OBP--control of the birth weight, induction of labour, cesarean delivery, intensified management of gestational diabetes. About 10-20% of patients with injuries of the brachial plexus require surgical intervention for optimal results.

Birth Injuries↗
PubMed2005

Comparison of "instrument-associated" and "spontaneous" obstetric depressed skull fractures in a cohort of 68 neonates.

OBJECTIVE: A depressed skull fracture is an inward buckling of the calvarial bones and is referred to as a "ping-pong" fracture. This study aimed to look at differences between "spontaneous" and "instrument-associated" depressed skull fractures. STUDY DESIGN: This retrospective, case-control analysis included every neonate who was admitted with a depressed skull fracture between 1990 and 2000. Cases after a spontaneous vaginal delivery, elective cesarean delivery, or cesarean delivery that was performed during labor without previous instrument use were classified as "spontaneous" (n = 18 cases). Cases after a delivery in which forceps or a vacuum cup had been used either successfully or unsuccessfully were classified as "instrument-associated" (n = 50 cases). Continuous data were analyzed with 2-tailed unpaired t tests; chi 2 analysis was used for nominal data. A probability value of <.05 was considered statistically significant. RESULTS: Fifty depressed skull fractures were associated with an instrument delivery, and 18 depressed skull fractures were classified as "spontaneous." The only obstetric parameter that differed significantly between the 2 groups was the length of the active phase. Among the 68 neonates, 15 neonates underwent prolonged second stage, forceps or manual head rotation, or forceps use during elective cesarean delivery. All "instrument-associated" cases were caused by forceps application or sequential instrument use; depressed skull fractures never occurred after isolated vacuum extraction. Every type of forceps was involved. Intracranial lesions were significantly more frequent in the instrument-associated group (30% vs 0%; P = .02). Two infants sustained persistent severe motor disabilities. CONCLUSION: Depressed skull fractures occur in the setting of spontaneous and operative deliveries, although the incidence is higher in the latter case. Depressed skull fractures that are associated with instrumental deliveries are significantly more likely to be associated with intracranial lesions. Persistent disabilities are rare.

Birth Injuries↗
PubMed1996

Factors associated with the use of episiotomy during vaginal delivery.

OBJECTIVE: To examine factors associated with the performance of episiotomy. METHODS: A retrospective review was performed on 8647 deliveries during 1991 and 1992 at five medical centers. Episiotomy rates were compared based on variables involving patient demographics, obstetric condition, and physician factors for the 6458 vaginal deliveries in the sample. Logistic regression modeling using variables associated in bivariate analysis was performed to examine independent effects of each variable. RESULTS: Several characteristics of the patient, her clinical status, and physician factors were all associated with episiotomy use. The strongest independent predictors of episiotomy were nulliparity (odds ratio [OR] 4.10, 95% confidence interval [CI] 3.59-4.68) and the use of forceps (OR 5.03, 95% CI 3.39-7.46) or vacuum extraction (OR 3.78, 95% CI 2.36-6.04). Provider specialty and the site of care were also associated independently with episiotomy. Episiotomy use was also associated with major perineal lacerations and an increased length of hospital stay. CONCLUSION: Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotomy.

Adult↗
PubMed1983

Parturition and pelvic fracture. Follow-up of 34 obstetric patients with a history of pelvic fracture.

Thirty-four women with a history of pelvic fracture gave birth. Ten had experienced increasing or recurrent pain during the course of their pregnancy. Twenty-seven women gave birth without complications, including 13 patients with displaced pelvis. In only one patient was cesarean section carried out on suspicion of disproportion. Cesarean section was carried out in another case because of resymphysiolysis and in one because of other complications to the pregnancy. Two underwent vacuum extraction because of secondary inertia, but subsequently they gave birth by the vaginal route without complications. In connection with pregnancy and birth, 2 patients had resymphysiolysis. They were the only patients of 8 with symphysiolysis who had undergone osteosynthesis, and both had had the material removed before pregnancy. It is concluded that separation of the symphysis in a pelvic fracture is a more serious complication in subsequent parturition than is displacement of the bony birth canal.

Adult↗
PubMed1995

Pudendal nerve damage increases the risk of fecal incontinence in women with anal sphincter rupture after childbirth.

AIM: To evaluate anal function after childbirth in 94 women in whom sphincter rupture occurred and in 19 control women. The findings of anorectal physiological assessment and history of childbirth were related to the presence of fecal incontinence. METHODS: Anal manometry and electromyography were performed the first days after childbirth and repeated 3 months post partum together with measurement of pudendal nerve terminal motor latency. RESULTS: Eighteen patients (19%) presented with incontinence. None of the controls developed fecal incontinence after delivery. Anal manometry showed that both incontinent and continent patients had decreased resting and squeeze pressures compared to control subjects (p < 0.005). No difference in anal electromyography was found between the three groups. Both anal manometry and electromyography showed a significant increase in pressure and activity respectively 3 months after delivery in patients and controls. Patients with pudendal nerve terminal motor latencies > 2.0 milliseconds had an increased risk of having fecal incontinence compared to patients with pudendal nerve terminal motor latencies < or = 2.0 milliseconds (odds ratio 2.18, p < 0.05). Fecal incontinence could not be related to the weight or head circumference of the infant. The manometric and electromyographic findings, the use of pudendal nerve block, the length of the second stage of labor, the depth of rupture or the use of vacuum extraction could not be related to either fecal incontinence or pudendal nerve function. CONCLUSION: The manometric findings indicated damage to the anal sphincter apparatus in both continent and incontinent patients. Decreased pudendal nerve function characterized incontinent women. Accurate prediction of fecal incontinence in women with obstetric anal sphincter rupture is not possible.

Adolescent↗
PubMed1984

[Improved Bamberg divergence forceps. Modification for the prevention of soft tissue injuries of the pelvis].

Constant and limited (max. 300 g) force of application by the Bamberg divergent forceps helps to prevent compression injuries and slippage of the forceps with resultant trauma. No serious foetal lesions have been observed over a period of 9 years. Maternal soft-tissue injuries were somewhat above the range of vacuum extractions. This prompted us to consider modifying the Bamberg forceps with a view towards preventing such maternal injuries.

Birth Injuries↗
PubMed1980

The problem of the older primipara.

The obstetric data relating to 98 older primiparas (OP) (0.21% of all deliveries) are compared with 100 randomly chosen older multiparas (OM) and 100 young primiparas (YP). Notable differences observed were a higher incidence of toxemia and a greater incidence of uterine myomata in the OP group. No difference was seen in the incidences of diabetes, cardiac disease, and essential hypertension. There was a greater number of preterm deliveries. The frequencies of induction of labor, vacuum extraction, and cesarean section were much greater in the OP group. No difference in postnatal course was detected among the 3 groups. No significant increase in perinatal morbidity was observed, but the incidences of prematurity and perinatal mortality were higher. It seems that the attending obstetrician is much quicker to decide to terminate pregnancy or labor ithe OP group. Except for the need for special attention to prematurity and perinatal mortality, the OP group is not at high risk.

Adult↗
PubMed2001

Clinical experience reported by candidates for the American Board of Obstetrics and Gynecology 1995 and 1997 oral examinations.

OBJECTIVE: The purpose of this study was to report the clinical experience collated from the 1995 and 1997 case list summary sheets of United States and Canadian active candidates who were completing the American Board of Obstetrics and Gynecology oral examination for the first time. STUDY DESIGN: Data from the case list summary sheets were entered into a computerized database and collated. Data from active candidates who had subspecialty training and from other international graduates were excluded. RESULTS: The difference in the ratio of men to women candidates between 1995 and 1997 was statistically significant (P =.02). Both years, 31% of the major operations were hysterectomies, of which 60% and 62.5%, respectively, were performed through an abdominal incision. The mean total cesarean delivery rate was 20.5% in 1995 and 19.7% in 1997. The ratio of primary to repeat cesarean deliveries was 2 to 1 in both years. The ratio of forceps to vacuum extraction deliveries was 3:7 in 1995 and 2:5 in 1997. CONCLUSION: This data set provides a national overview of the clinical experiences of a relatively homogeneous group of practicing obstetrician-gynecologists who have recently completed their training.

Certification↗
PubMed1982

Cardiotocography supplemented with continuous fetal pH monitoring during labor. Effect on rate of obstetrical interventions and neonatal condition.

Continuous monitoring of the fetal scalp tissue pH (tpH) was performed in 96 consecutive cases. Of these 96, 72 (75%) had acceptable pH tracings which were used for the management of labor (series II). These 72 patients were compared with 72 patients from an earlier series (series I) of tpH monitoring in which pH was not used in the management of labor (matched according to age and parity). A significant decrease in the number of forceps and vacuum extractions (from 25.8 to 8.6%) and in the total number of interventions (from 36.1 to 15.3%) because of suspected fetal distress was observed when tpH was used in the management of labor. The state of the newborns (Apgar score 1 and 5 min after delivery; umbilical artery and vein pH, pCO2, base excess, standard bicarbonate, pO2, oxygen saturation, and hemoglobin) was equal in the two series, except for a slightly greater oxygen saturation of the umbilical artery and a slightly lower umbilical vein pH in series II. It is concluded that tpH monitoring of the fetus during labor can reduce the number of interventions, but the method still needs further development and clinical evaluation.

Apgar Score↗
PubMed1981

[Pituitary-adrenal cortical function in newborn infants--especially in the ratio of unbound unconjugated corticosteroids (author's transl)].

It has already generally been accepted that there are a variety of fetal adaptations to a stress during delivery and the fetal endocrinological functioning is being controlled mainly by the pituitary adrenal axis. An endocrinological difference between fetuses given a stress and the controls was observed in this study. The levels of ACTH and cds in the umbilical cord blood are supposed to be the indicators of stresses. The measurements of not only those levels but the percentile value of non-protein bound cds (NPC), known for an active form, were conducted under various conditions. Consequently, the three following results were obtained. 1. In the group of infants delivered by the vacuum extraction, the levels of ACTH and percent free cds tended to be more increased, and those of total cds and NPC were significantly higher than both groups of infants delivered spontaneously and by the oxytocin induction. 2. There were no significant differences in the levels of ACTH, total cds, percent free cds and NPC in plasma between the groups of mothers when delivered spontaneously and by the vacuum extraction. 3. The levels of ACTH, total cds, percent free cds and NPC in umbilical cord blood in infants with asphyxia were significantly higher than the normal.

Adrenal Cortex Hormones↗
PubMed1998

Shoulder dystocia: fifteen years' experience in Ramathibodi Hospital.

Although shoulder dystocia does not occur frequently the adverse effect to the patient and especially to infants can be catastrophic. The purpose of this study was to evaluate the incidence, the factors which may be related to or predispose to this condition and the consequence to the patients and their infants. All cases of shoulder dystocia which occurred during the fifteen year period from January 1982 to December 1996 were scrutinized. There were 17 cases of shoulder dystocia from a total of 109,923 deliveries giving the incidence of 1.6 per 10,000 deliveries. Of these 17 patients, 11 (65%) were delivered by vacuum extraction. Two patients had postpartum hemorrhage requiring blood transfusion. Infants' birthweights ranged between 3350 to 5160 grams. Erb's palsy occurred in 6 infants and all made full recovery subsequently.

Delivery, Obstetric↗
PubMed1993

Are physicians changing the way they practise obstetrics?

OBJECTIVE: To examine trends in obstetric interventions in women at low risk over approximately 3 years. It was postulated that there would be a general reduction in most intervention rates. DESIGN: Retrospective review of hospital records. SETTING: Three downtown hospitals of the University of Toronto, in which academic and nonacademic family physicians and obstetricians practised. PATIENTS: A total of 2365 women in phase 1 (April 1985 to March 1986) and 1277 in phase 2 (May to September 1988) met the inclusion criteria for grade A (pregnancy at no predictable risk) of the Ontario Antenatal Record at the time of admission to hospital. OUTCOME MEASURES: Rates of artificial rupture of the membranes, induction, augmentation, epidural anesthesia, continuous electronic fetal monitoring (EFM), instrumental delivery, episiotomy and cesarean section. RESULTS: The family physicians and the obstetricians had significant decreases (p < 0.01) over time in the rates of episiotomy, especially mediolateral, and low forceps delivery. The rate of epidural anesthesia decreased significantly in the obstetrician group. The rates of artificial rupture of the membranes, induction and continuous EFM increased in the two physician groups; the increased rate of EFM was significant in the obstetrician group (p < 0.01). There was no significant change in the rates of augmentation, midforceps delivery, vacuum extraction or cesarean section. All of the trends were found to hold when the intervention rates were analysed according to the women's parity. CONCLUSIONS: Some of the findings reflect recommendations and trends reported in the literature, whereas others are not supported by clear medical evidence. The unpredictable nature of the trends suggests that further study is warranted of the reasons for obstetric trends and for the changes in physicians' practice patterns.

Anesthesia, Epidural↗
PubMed1975

Placental insufficiency in relation to postterm pregnancy and fetal postmaturity. Evaluation of fetoplacental function; management of the postterm gravida.

As pregnancy extends post term, incidence of placental insufficiency, fetal postmaturity (dysmaturity), and fetal perinatal death increases rapidly as a consequence of reduced respiratory and nutritive placental function. Despite a compensatory fetoplacental respiratory reserve capacity, fetal distress is observed in about one third of postterm pregnancies. On a biochemical level, placental pathophysiology in postterm-postmaturity pregnancies is not well understood. Postmaturity is correlated with increased incidence of placental lesions, fetal hypoxia-asphyxia, intrauterine growth retardation, increased perinatal death, and neonatal morbidity. Early diagnosis of fetal postmaturity is difficult because currently applied test methods allow recognition only when placental insufficiency is far progressed. Therefore, in postterm gravidas with a favorable cervix, induction of labor should be considered; in older primigravidas, in whom fetal losses may be sevenfold increased, or in multiparas with a history of obstetric complications, pregnancy may require termination by cesarean section. Pregnancy may be allowed to continue under close supervision in cases of uncertainty of duration of gestation, in gravidas carrying small babies, in young primigravidas, and in multigravidas in whom placentofetal function tests are normal. As long as fetal scalp blood sampling during labor does not show fetal acidosis, despite abnormal fetal heart rate pattern and meconium release, vaginal delivery may be attempted when deemed possible within a few hours. In parturients attention must be paid to the extent of uterine activity and type of medication; lateral positioning of the gravida and maternal oxygen breathing, facilitating fetal oxygen supply, are important features. Because during bearing-down efforts placentofetal respiratory reserves of postterm gravidas may become further compromised, immediate delivery by forceps or vacuum extraction may be considered. After delivery the umbilical cord should not be clamped immediately in order to allow increased fetal blood supply and to counteract fetal hypovolemia. Dysmature newborn infants require special care by the neonatologist.

Adrenocorticotropic Hormone↗
PubMed2001

Third and fourth degree perineal tears. Predictor factors in a referral hospital.

BACKGROUND: Tears of the anal sphincter are a feared complication of vaginal delivery, as many as 50% of these patients experience incontinence as an after-effect. Identifying significant predictor factors leading to third or fourth degree perineal tears during vaginal delivery was the objective of this study. METHODS: During a two-year period (1995-1996), a third or fourth degree perineal rupture occurred in 214 women (3.7%) after vaginal delivery. Data from these deliveries were collected and compared to data from deliveries without anal sphincter tears in order to identify risk factors. A stepwise logistic regression model was used for the analysis. RESULTS: Independent risk factors of significance were vaginal nulliparity, a squatting position on a delivery chair, maternal age exceeding 35 years, baby's birth weight over 4000 g, vacuum extraction (both outlet and mid release), median episiotomy, oxytocin augmentation and birthing between 3 a.m. and 6 a.m. CONCLUSIONS: This study identified several factors associated with anal sphincter tears. Median episiotomy should be avoided. Delivery, while squatting on a low chair, should be used with caution. A woman with one or more risk factors requires caution by birth attendants during delivery. Gynecologists should consider the option of cesarean section instead of vacuum extraction, especially when mid release is needed in the presence of macrosomia. A continuous audit regarding instrumental delivery technique is necessary.

Adult↗