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 1,423 records · Page 79Linked to original sources

PubMed1993

Anal-sphincter disruption during vaginal delivery.

BACKGROUND: Lacerations of the anal sphincter or injury to sphincter innervation during childbirth are major causes of fecal incontinence, but the incidence and importance of occult sphincter damage during routine vaginal delivery are unknown. We sought to determine the incidence of damage to the anal sphincter and the relation of injury to symptoms, anorectal physiologic function, and the mode of delivery. METHODS: We studied 202 consecutive women six weeks before delivery, 150 of them six weeks after delivery, and 32 with abnormal findings six months after delivery. Symptoms of anal incontinence and fecal urgency were assessed, and anal endosonography, manometry, perineometry, and measurement of the terminal motor latency of the pudendal nerves were performed. RESULTS: Ten of the 79 primiparous women (13 percent) and 11 of the 48 multiparous women (23 percent) who delivered vaginally had anal incontinence or fecal urgency when studied six weeks after delivery. Twenty-eight of the 79 primiparous women (35 percent) had a sphincter defect on endosonography at six weeks; the defect persisted in all 22 women studied at six months. Of the 48 multiparous women, 19 (40 percent) had a sphincter defect before delivery and 21 (44 percent) afterward. None of the 23 women who underwent cesarean section had a new sphincter defect after delivery. Eight of the 10 women who underwent forceps delivery had sphincter defects, but none of the 5 women who underwent vacuum extractions had such defects. Internal-sphincter defects were associated with a significantly lower mean (+/- SD) resting anal pressure (61 +/- 11 vs. 48 +/- 10 mm Hg, P < 0.001) six weeks post partum, and external-sphincter defects were associated with a significantly lower squeeze pressure (increase above resting pressure, 70 +/- 38 vs. 44 +/- 13 mm Hg; P < 0.001). There was a strong association (P < 0.001) between sphincter defects and the development of bowel symptoms. CONCLUSIONS: Occult sphincter defects are common after vaginal delivery, especially forceps delivery, and are often associated with disturbance of bowel function.

Adolescent↗

PubMed1987

[Studies on the influence of maternal delivery position on fetal status].

The maternal delivery position was evaluated in 148-full term parturient women with various factors including quantitative fetal heart rate (FHR) analysis, the duration of delivery, neonatal Apgar score, the gases and catecholamine in umbilical cord arterial blood and neonatal heart rate (NHR) at 5 minutes after birth. FHR factors, including the FHR score, fetal distress (FD) index, FHR baseline, its variability and acceleration were determined every 5 minutes with a microcomputerized automatic analyser. The rates of vacuum extraction and neonatal depression were lower in the sitting primiparous group than in the supine group. The catecholamine in the umbilical arterial blood and the 5 minutes NHR showed insignificant differences between the two groups. Blood gases in the umbilical arterial blood in the multiparous supine group were significantly better (p less than 0.05) than in the sitting group. The FD index was lower in the primiparous sitting group than that in the supine. The FHR score, FHR baseline and variability amplitude in the sitting group were better than that in the supine. However, there was no significantly favorable difference between factors for any of the sitting and supine groups analysed.

Blood Gas Analysis↗

PubMed1994

Common intrapartum denominators of shoulder dystocia related birth injuries.

The intrapartum background of fetal injuries associated with shoulder dystocia was studied retrospectively on the basis of 107 relevant medical records. Intrapartum use of oxytocin and protraction-arrest disorders, the latter particularly during the second stage of labor, were frequent findings. Delivery was effected by forceps or vacuum extraction in almost one-half of the cases. Shoulder dystocia related permanent fetal impairments were closely connected to macrosomia. The fetal weight was > or = 4,000 grams in about 75% and > or = 4,500 grams in approximately 40% of the instances. Permanent hypoxic or traumatic cerebral damage was documented in almost one-third of the cases. The data indicate that in connection with coincidental neonatal afflictions, the birth weights of the fetuses are higher and instrumental extractions are more frequent than in relation to all clinically diagnosed cases of shoulder dystocia.

Adolescent↗

PubMed1995

A thrombogenic uterine pack for postpartum hemorrhage.

BACKGROUND: A low-lying placenta or placenta previa is frequently associated with postpartum hemorrhage from a low implantation site. We describe the successful use of a thrombin-soaked uterine pack for this condition. CASE: A 30-year-old woman, gravida 3, para 0-0-2-0, had placenta previa diagnosed by ultrasound at 26 weeks' gestation. A repeat examination at 35 weeks demonstrated a low-lying placenta. The patient had an uncomplicated intrapartum course and was delivered by vacuum extraction, but excessive vaginal bleeding was noted 3 hours after spontaneous delivery of the placenta. Oxytocin, prostaglandin, and uterine curettage failed to control the hemorrhage. In an attempt to avoid laparotomy, we placed a thrombin-soaked uterine pack over the bleeding site. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. The patient had no further complications and was released 3 days after delivery. CONCLUSION: A thrombin-soaked uterine pack may successfully control lower uterine segment bleeding following delivery of a patient with a low-lying placenta. This technique offers the obstetrician another treatment option in selected cases of postpartum hemorrhage.

Administration, Topical↗

PubMed2004

Labor course and delivery in epidural analgesia: a case-control study.

BACKGROUND: We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. METHODS: We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. RESULTS: Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( +/- standard deviation) gestational age at delivery was 39.4 +/- 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B. The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. CONCLUSION: Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.

Adult↗

PubMedDate not supplied

[Pregnancy and labor in women over 40 years of age].

During the 1970-1989 period, there were 23,915 deliveries of which 278 (1.16%) occurred in women 40 years of age or older. The latter included 62 (22.3%) primiparas, 158 (56.8%) pluriparas and 58 (20.9%) multiparas. The control group consisted of 14,400 women 20-34 years of age (50% primiparas and 50% pluriparas) from the same period. There was no antenatal visit in 9.4% of the women 40 years of age or older. This group included more housewives, more unmarried women and more women with previous spontaneous and induced abortions than the control group (P less than 0.05). Threatened abortion (16.2%), EPH gestosis (22.3%), impaired glucose tolerance (8.3%), gestational diabetes (7.2%), delivery before 37 weeks (11.5%), delivery after 42 weeks (3.6%), premature rupture of the membranes (18.3%), meconium-stained amniotic fluid (19.8%), elective caesarean section (11.5%), caesarean section delivery (16.5%), vacuum extraction (4.7%), placental lysis or uterine exploration (4.3%) were more frequent in the study than in the control group (P less than 0.05). There were more cases with episiotomy (P less than 0.001) in the control group, whereas there were no differences as regards cervical cerclage, weight gain above 14kg, breech presentation, transverse presentation and assisted breech delivery between the two groups (P greater than 0.05). There was no case of uterine rupture or maternal death either in the study or the control group. The authors conclude that a woman 40 years of age and older is in an advanced age for pregnancy and delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

A twenty-year retrospective analysis of the efficacy of epidural analgesia-anesthesia when administered and/or managed by obstetricians.

OBJECTIVE: The purpose of this study was to retrospectively determine the safety and efficacy of epidural anesthesia when administered by obstetricians in a community hospital. STUDY DESIGN: Data containing 14,598 epidural procedures from 31,818 births were obtained from delivery room logs over a period of 20 years, from 1972 through 1991. Data were displayed graphically to view trends over time. Odds ratios were calculated to determine the associations of epidural anesthesia with oxytocin stimulation, episiotomy, assisted vaginal delivery (forceps or vacuum extraction), and cesarean section. Particular scrutiny was given to any listed complication during labor or delivery. RESULTS: Over the 20-year period epidural anesthesia was administered without serious complication by various obstetricians with different training. Technique improved as procedures became standardized, resulting in an increase in the number of epidural procedures over the 20-year period. Incidence was also increased among women requiring oxytocin augmentation, episiotomies, and assisted vaginal deliveries. Of the total number performed, < 5% of patients required additional anesthesia. CONCLUSION: Over a 20-year period epidural analgesia or anesthesia has been an effective and safe procedure when performed and supervised by obstetricians-gynecologists in a community hospital.

Analgesia, Epidural↗

PubMed1985

Influence of glucocorticoid and betamimetic therapy on milk secretory IgA concentration produced by mothers delivering preterm infants.

A prospective study was performed to find the possible difference in secretory IgA concentration in milk of mothers with term pregnancy labors and those delivering at earlier gestational ages. Since tocolytic drugs and/or glucocorticoid agents are usually given in cases of threatened premature labor, the pre-term group was divided into mothers with or without medication. Thirty two mothers were distributed in three groups: Group I, mothers with preterm labors without any medication; Group II, preterm labors with previous treatment with betamimetics and glucocorticoids; Group III, term labors (see Tab. I). In each of the three groups, three periods were studied: colostral (4 to 5 days postpartum), transitional (8 to 10 days), and mature (14 to 15 days). All mothers were healthy, with good nutritional state, without local inflammation and membranes had been ruptured 12 hours or less before labor. There was no significant difference in the proportion of primiparas and multiparas in both groups. The gestational age was evaluated by amenorrhea and neonatal examination. In all mothers milk was extracted with a vacuum pump to empty the mammary gland. The determinations were made using a specific antibody against the secretory component. The concentration of free secretory component in these milks was practically insignificant. No differences were found in the concentration of secretory IgA among the three groups (Tab. II, Fig. 1) in the periods that were studied, colostral, transitional or mature. The farther away from labor that milk extraction was made, in the periods considered in our study, there is a progressive decrease in the concentration of secretory IgA (Fig. 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

Waterbirths compared with landbirths: an observational study of nine years.

AIMS: This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded). METHODS: In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths. RESULTS: Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. Waterbirths show a higher rate of births "without injuries", first and second-degree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU. During the study, there were neither maternal nor neonatal deaths related to spontaneous labor. CONCLUSIONS: Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed.

Adult↗

PubMed1989

Postdelivery head bleeding in hemophilic neonates. Causes and management.

During a 12-month period, four of the five infants with hemophilia known to have been born in Arkansas were examined for head bleeding. Three of the infants had had traumatic delivery, with use of low forceps in two and vacuum extraction in one. In the fourth patient, hemophilia was prenatally diagnosed, and vaginal delivery resulted in cephalohematoma. Diagnosis was delayed in three patients, including one with a family history of hemophilia. Central nervous system bleeding may be more common in hemophilic neonates than has been presumed. Pregnancy management should include consideration of family history of bleeding disorders and carrier testing in appropriate cases. In confirmed carriers, prenatal diagnosis is justified to allow choice of the least traumatic delivery method. Any term neonate with intracranial hemorrhage should be treated as being possibly hemophilic until proved otherwise.

Cerebral Hemorrhage↗

PubMedDate not supplied

[Air embolism in a labor with uterine rupture].

Owing to the asphyxia of the child weighing 4460 g, the delivery of a 33-year-old secundipara was completed by vacuum extraction. In the course of delivery the patient was bleeding very little. Following the delivery she complained of the numbness of the left hand and headache, she was pale, restless, and all in a cold sweat. The blood pressure was unmeasurable and the peripheral pulse could not be felt. Reanimation started at once. After a short improvement the patient's condition was getting worse. For suspected intra-abdominal hemorrhage, abdominal hysterectomy was applied. The operation revealed the incomplete rupture of the uterus. The patient died in the course of the operation. Venous air embolism was diagnosed only during obduction and was most probably the consequence of air aspiration through the split uterine veins.

Adult↗

PubMed1979

[Mode of delivery, postnatal condition and neonatal outcome in preterm infants].

There were under examination 578 preterm infants of two groups--28. up to 31. and 32. up to 36. week of gestation--after birth of vertex as well as breech prevention. Postnatal condition and neonatal outcome were put into relation to the mode of delivery. We compared Apgar-Score (one and five minute value), morbidity on respiratory distress syndrom as well as rate of survival and neonatal mortality in spontaneous delivery with and without episiotomia, with specula delivery, Shute-forceps and vacuum extraction of vertex presentation as well as with breech presentation after vaginal delivery and primary Caesarean section. In respect of the management of the second stage of labour it is our opinion that prophylactic additional measures in preterm delivery of vertex presentation after 32 weeks of gestation are not necessary and that this question should be examined in a larger study of much more cases. But we were able to demonstrate that up to 32. week of gestation well-timed episiotomia of optimal size is necessary. Our good experiences in breech presentation between 31. and 35. week of gestation treated by obligate Caesarean section have to prove true in future.

Apgar Score↗

PubMed1983

Fetal activity acceleration during early labor.

Altogether 59 women (53 normal and 6 high-risk pregnancies) underwent a fetal activity acceleration determination (FAD) during the first stage of labor. 52 FAD were considered reactive, while 5 were non-reactive and 2 technically inadequate. Four of the 5 fetuses with a non-reactive FAD showed signs of fetal compromise during labor and 1 died intra-uterinely. There were significantly more normal births and non-compromised fetuses in the FAD reactive group than in the non-reactive (p less than 0.002, chi 2-test), while there were significantly more acute cesarean sections in the non-reactive group (p less than 0.001, chi 2-test). Of the 12 vacuum extractions (all in the FAD reactive group) 4 were performed because of prolonged 2nd stage and 8 because of suspected because of prolonged 2nd stage and 8 because of suspected intra-uterine asphyxia, but all infants did well after delivery, and the umbilical arterial pH was in all cases above 7.15. It is concluded that when a FAD test is reactive in the first stage of labor, one can expect a positive outcome of the birth, whereas a non-reactive test arouses suspicion of fetal compromise and implies that one must carefully monitor the progress of the birth so that the fetus can be delivered promptly if any sign of late decelerations should appear. A reactive FAD is, on the other hand, rather reassuring for the fetal state.

Delivery, Obstetric↗

PubMed1977

[Analysis of therapeutic success and of obstetrical results in sterile marriages].

In the course of sterility therapy 375 pregnancies were observed in 296 patients. 63 women conceived twice or more. At the first visite the mean age of the patients was 25,8 years, the mean duration of sterility 2,7 years. A primary sterility was observed in 207 and a secondary sterility in 98 cases. The main therapeutic procedure was the induction of ovulation with FSH/LH releasing preparations (Clomiphen, Cyclofenil, Epimestrol) (40,3%), followed by the substitution therapy with human gonadotrophins (22,7%). 78 pregnancies ended by spontaneous and 4 by artificially induced abortion. The abortion rate in this study was 20,8 %, exceeding considerably the normal abortion rate. The rate of extrauterine pregnancies was also increased, being 2,4%. There was no significant difference in the abortion rate of pregnancies with or without induction of ovulation. The age at the time of conception and the duration of therapy had no significant influence on the rate of abortions. In 293 pregnancies the duration of gestation exceeded the 28th week. However, 33,1% of these pregnancies had complications that required hospitalisation. Almost 50% of the complications consisted of threatened abortion. The mean duration of gestation was reduced by 5 days, caused by a relatively high frequency of early births (16,9%). The mode of delivery of our patients was in 68,8% spontaneous delivery, in 16,2% caesarian section, in 15,0% forceps or vacuum extractions. This corresponds to the general mode of delivery of our hospital. Only after gonadotrophin therapy a higher caesarian section rate of 26,8% was noted. Out of the 310 live born children, 9,2% had a weight below 2500 g, owing to a multiple pregnancy rate of 4,1%. 4% of the children showed the signs of dystrophia. The perinatal mortality amounted to 5,1%. However, when the gonadotrophin induced multiple pregnancies are excluded, the rate is 2,7%. Only 2 cases of malformations were observed.

Adult↗

PubMed2005

Risk factors of pneumothorax during the first 24 hours of life.

BACKGROUND: Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition. MATERIAL AND METHOD: This is a retrospective case-control study. CASEs were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases. CASE: control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05. RESULTS: There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9). CONCLUSION: All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.

Case-Control Studies↗

PubMed1975

[Deliveries in foreign women (author's transl)].

Within four and a half years (between January 1, 1969 and June 30, 1973) there were 6329 deliveries, among them 1217 confinements occurred in foreign women, i.e. proportional 19, 2%. The chi square method was used for the statistical analysis. The incidence of Caesarean Section in foreign women (5, 3%) is significantly higher than in German women (3, 4%). Just so, the incidence of Caesarean Section in wives of foreign workers from Spain and Portugal was significantly higher than in German women; it looks like as if the indication "Pelvic contraction" appears significantly more frequent in parturients of the western part of the mediterranean area than in German women. On the contrary, the indication "fetal distress" is significantly higher in the deliveries of the wives from Greece and Turkey (the eastern part of the mediterranean area). There was no statistical difference in the rate of forceps deliveries and deliveries by vacuum between the German collective (6, 1%) and the foreign collective (7, 5%). Statistically proved, the incidence of the incidence of the indication "fetal distress" in vaginal-operative deliveries of women from Turkey was higher compared to the German collective. Vice versa it turned out that the incidence of the indication "standstill on floor of the pelvis" occurred more often in German parturients than of the collective of Turkey. There was a second statistical method (randomization) to check up if the collectives are comparable; there exists a significant difference between German parturients and women from Turkey: in the German collective are more young and old I.-Parae, in the collective from Turkey you find more Multiparae and more wives in the optimal obstetrical age between 18 and 30 years. The subsequent obstetrical aspects and consequences are discussed. There was no significant difference between foreign and German parturients in further perinatal examinations and parameters.

Adolescent↗

PubMed1990

[Neurobehavior and mental development of newborn infants delivered under epidural analgesia with bupivacaine].

The neurobehavior of newborn infants delivered under epidural analgesia with bupivacaine was analyzed by Amiel-Tison's Neurological and Adaptive Capacity Score (NACS), while Tsumori-Image's questionnaire assessed the above infants' mental development. Seventy-two newborn infants under epidural analgesia (39 delivered spontaneously and 33 by vacuum extraction) and twenty-eight newborn infants without epidural analgesia as controls (15 delivered spontaneously and 13 by vacuum extraction) were under study. The following results were obtained 1) In the 24 hour period following childbirth, NACS tended to be low in relation to the total dosage of bupivacaine administered to the mother. 2) In the 24 hour period following childbirth and continuing until the 3rd day, NACS were relatively low regardless of the mode of delivery. 3) There was no significant difference between the neonatal physiological weight loss in newborn infants under epidural analgesia and those without epidural analgesia (controls). 4) Newborn infants under epidural analgesia displayed an average mental quotient at the first, third, and sixth month after childbirth. Although epidural analgesia with bupivacaine might lower the neurobehavior of newborn infants in the immediate postchildbirth period, the newborn infants should return to normal without any complications.

Anesthesia, Epidural↗

PubMed2000

A population-based cohort study of birth and neonatal outcome in older primipara.

OBJECTIVES: To examine the risk of adverse birth outcome in older primiparous women. METHODS: We identified 14,676 primiparae of 20 years of age or more from 1991 to 1996 using the Birth Registry in the North Jutland County, Denmark. We evaluated the risk of adverse birth outcome in the primiparous women aged 30-34 years and above 35 years using the primiparae aged 20-29 years at time of birth as reference. RESULTS: The risks of induced labor, perineotomy, stimulating contraction and vacuum extraction were significantly higher (adjusted odds ratio: 1.3 to 1.7) in the primiparae of 35 years or more. The odds ratio for cesarean section delivery was 2.1 (95% confidence interval: 1.7-2.6) and the odds ratio for delivering a low birth weight child among the primiparae of 35 years or more was 2.2 (95% confidence interval: 1.4-3.3) compared with the primiparae of 20-29 years of age. These risk estimates were independent of women's infertility treatment history. CONCLUSIONS: A negative effect of maternal age on birth and neonatal outcome may be seen even after 30 years of age and is partly related to chronic diseases. However, it is impossible to rule out selection bias, but the actual risk must be taken into consideration in antenatal care.

Adult↗