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Kong CW, To WWK. Precision of vacuum cup placement and its association with subgaleal hemorrhage and associated morbidity in term neonates. Arch Gynecol Obstet 2024; 309:1411-1419. [PMID: 37017783 DOI: 10.1007/s00404-023-07018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE To evaluate whether the precision of vacuum cup placement is associated with failed vacuum extraction(VE), neonatal subgaleal hemorrhage(SGH) and other VE-related birth trauma. METHODS All women with singleton term cephalic fetuses with attempted VE were recruited over a period of 30 months. Neonates were examined immediately after birth and the position of the chignon documented to decide whether the cup position was flexing median or suboptimal. Vigilant neonatal surveillance was performed to look for VE-related trauma, including subgaleal/subdural hemorrhages, skull fractures, scalp lacerations. CT scans of the brain were ordered liberally as clinically indicated. RESULTS The VE rate was 5.89% in the study period. There were 17(4.9%) failures among 345 attempted VEs. Thirty babies suffered from subgaleal/subdural hemorrhages, skull fractures, scalp lacerations or a combination of these, giving an incidence of VE-related birth trauma of 8.7%. Suboptimal cup positions occurred in 31.6%. Logistic regression analysis showed that failed VE was associated with a non-occipital anterior fetal head position (OR 3.5, 95% CI 1.22-10.2), suboptimal vacuum cup placement (OR 4.13, 95% CI 1.38-12.2) and a longer duration of traction (OR 8.79, 95% CI 2.13-36.2); while, VE-related birth trauma was associated with failed VE (OR 3.93, 95% CI 1.08-14.3) and more pulls (OR 4.07, 95% CI 1.98-8.36). CONCLUSION Suboptimal vacuum cup positions were related to failed VE but not to SGH and other vacuum-related birth trauma. While optimal flexed median cup positions should be most desirable mechanically to effect delivery, such a position does not guarantee prevention of SGH.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China.
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong, China
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Schreiber H, Cohen G, Shalev-Ram H, Heresco L, Daykan Y, Arbib N, Biron-Shental T, Markovitch O. Vacuum-assisted delivery outcomes: is advanced maternal age a factor? Arch Gynecol Obstet 2024; 309:1281-1286. [PMID: 36867307 DOI: 10.1007/s00404-023-06983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). METHODS This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. RESULTS From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). CONCLUSION Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heresco
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kamwesigye A, Nolens B, Kayiga H, Muriuki M, Muzeyi W, Beyeza-Kashesya J. Mode of birth in subsequent pregnancy when first birth was vacuum extraction or second stage cesarean section at a tertiary referral hospital in Uganda. BMC Pregnancy Childbirth 2024; 24:98. [PMID: 38302920 PMCID: PMC10832167 DOI: 10.1186/s12884-024-06282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/21/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The trends of increasing use of cesarean section (CS) with a decrease in assisted vaginal birth (vacuum extraction or forceps) is a major concern in health care systems all over the world, particularly in low-resource settings. Studies show that a first birth by CS is associated with an increased risk of repeat CS in subsequent births. In addition, CS compared to assisted vaginal birth (AVB), attracts higher health service costs. Resource-constrained countries have low rates of AVB compared to high-income countries. The aim of this study was to compare mode of birth in the subsequent pregnancy among women who previously gave birth by vacuum extraction or second stage CS in their first pregnancy at Mulago National Referral Hospital, Uganda. METHODS This was a retrospective cohort study that involved interviews of 81 mothers who had a vacuum extraction or second stage CS in their first pregnancy at Mulago hospital between November 2014 to July 2015. Mode of birth in the subsequent pregnancy was compared using Chi-2 square test and a Fisher's exact test with a 0.05 level of statistical significance. RESULTS Higher rates of vaginal birth were achieved among women who had a vacuum extraction (78.4%) compared to those who had a second stage CS in their first pregnancy (38.6%), p < 0.001. CONCLUSIONS AND RECOMMENDATIONS Vacuum extraction increases a woman's chance of having a subsequent spontaneous vaginal birth compared to second stage CS. Health professionals need to continue to offer choice of vacuum extraction in the second stage of labor among laboring women that fulfill its indication. This will help curb the up-surging rates of CS.
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Affiliation(s)
- Assen Kamwesigye
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, Mbale, P.O. Box 921, Uganda.
| | | | - Herbert Kayiga
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Muriuki
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Wani Muzeyi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Jolly Beyeza-Kashesya
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
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Wang Y, Niu Y, Xu Z, Yan X, Li J, Xu H. Association of the Kiwi OmniCup system with maternal and neonatal morbidity: A retrospective cohort study. Int J Gynaecol Obstet 2024; 164:699-707. [PMID: 37587733 DOI: 10.1002/ijgo.15037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To discuss the effect of the Kiwi OmniCup system on reducing adverse maternal and neonatal outcomes and provide a reference for assisted vaginal delivery methods. METHODS Women who gave birth to singleton term neonates in a cephalic presentation and underwent assisted vaginal delivery from 2017 to 2021 were eligible for inclusion in the study; they were divided into a Kiwi OmniCup system group and a forceps group. Binary logistic regression analysis was used to observe and compare maternal and neonatal outcomes. The primary outcomes were severe maternal and neonatal morbidity. Severe maternal morbidity was defined as the occurrence of at least one of the following outcomes: third- or fourth-degree perineal lacerations, refractory postpartum hemorrhage, thrombotic events, amniotic fluid embolism, admission to the intensive care unit, and maternal death. Severe neonatal morbidity was defined as the occurrence of at least one of the following outcomes: neonatal asphyxia requiring resuscitation or intubation, neonatal head and face injuries, neonatal fracture, and admission to the neonatal intensive care unit for longer than 24 h. RESULTS The rate of severe neonatal morbidity in the forceps group was significantly higher than that in the Kiwi OmniCup system group, the differences between the two groups were significant (27.2% vs. 42.3%, P < 0.001), and there was no significant difference in the rate of severe maternal morbidity between the two groups (30% vs. 30%, P > 0.05). Binary logistic regression analysis showed that Kiwi OmniCup system-assisted delivery reduced severe neonatal morbidity (adjusted odds ratio 0.49; 95% confidence interval 0.33-0.73) and did not increase severe maternal morbidity compared with forceps-assisted delivery. CONCLUSION The Kiwi OmniCup system, which can reduce the incidence of severe neonatal morbidity without increasing the incidence of serious adverse maternal outcomes, is worthy of clinical promotion.
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Affiliation(s)
- Yue Wang
- Chongqing Red Cross Society Hospital (Jiangbei People's Hospital), Chongqing, China
- Dalian Medical University, Dalian, China
| | - Yanxia Niu
- Dalian Medical University, Dalian, China
| | - Ziyi Xu
- Dalian Medical University, Dalian, China
| | | | - Jinhang Li
- Dalian Medical University, Dalian, China
| | - Hongbin Xu
- The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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Auger N, Wei SQ, Ayoub A, Luu TM. Severe neonatal birth injury: Observational study of associations with operative, cesarean, and spontaneous vaginal delivery. J Obstet Gynaecol Res 2023; 49:2817-2824. [PMID: 37772655 DOI: 10.1111/jog.15801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/16/2023] [Indexed: 09/30/2023]
Abstract
AIM To determine the association of successful and unsuccessful operative vaginal delivery attempts with risk of severe neonatal birth injury. METHODS We conducted a population-based observational study of 1 080 503 births between 2006 and 2019 in Quebec, Canada. The main exposure was operative vaginal delivery with forceps or vacuum, elective or emergency cesarean with or without an operative vaginal attempt, and spontaneous delivery. The outcome was severe birth injury, including intracranial hemorrhage, brain and spinal damage, Erb's paralysis and other brachial plexus injuries, epicranial subaponeurotic hemorrhage, skull and long bone fractures, and liver, spleen, and other neonatal body injuries. We determined the association of delivery mode with risk of severe birth injury using adjusted risk ratios (RR) and 95% confidence intervals (CI). RESULTS A total of 8194 infants (0.8%) had severe birth injuries. Compared with spontaneous delivery, vacuum (RR 2.98, 95% CI 2.80-3.16) and forceps (RR 3.35, 95% CI 3.07-3.66) were both associated with risk of severe injury. Forceps was associated with intracranial hemorrhage (RR 16.4, 95% CI 10.1-26.6) and brain and spinal damage (RR 13.5, 95% CI 5.72-32.0), while vacuum was associated with epicranial subaponeurotic hemorrhage (RR 27.5, 95% CI 20.8-36.4) and skull fractures (RR 2.04, 95% CI 1.86-2.25). Emergency cesarean after an unsuccessful operative attempt was associated with intracranial and epicranial subaponeurotic hemorrhage, but elective and other emergency cesareans were not associated with severe injury. CONCLUSIONS Operative vaginal delivery and unsuccessful operative attempts that result in an emergency cesarean are associated with elevated risks of severe birth injury.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Shu Qin Wei
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, University of Montreal, Montreal, Quebec, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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Muraca GM, Ralph LE, Christensen P, D'Souza R, Geoffrion R, Lisonkova S, Joseph KS. Maternal and neonatal trauma during forceps and vacuum delivery must not be overlooked. BMJ 2023; 383:e073991. [PMID: 37857419 PMCID: PMC10585424 DOI: 10.1136/bmj-2022-073991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Giulia M Muraca
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | | | - Penny Christensen
- Public representative, Birth Trauma Canada, Saint John, New Brunswick, Canada
| | - Rohan D'Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Blum M, Hochler H, Sela HY, Peled T, Ben-Zion O, Weiss A, Lipschuetz M, Rosenbloom JI, Grisaru-Granovsky S, Rottenstreich M. Failed vacuum and preterm delivery risk in the subsequent pregnancy: a multicenter retrospective cohort study. Am J Obstet Gynecol MFM 2023; 5:101121. [PMID: 37558127 DOI: 10.1016/j.ajogmf.2023.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/30/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Second-stage cesarean delivery is associated with subsequent preterm delivery. Failed vacuum-assisted delivery is a subgroup of second-stage cesarean delivery in which the fetal head is engaged deeper in the pelvis and, thus, is associated with an increased risk of short-term maternal complications. OBJECTIVE This study aimed to investigate the maternal and neonatal outcomes of women at their subsequent delivery after a second-stage cesarean delivery with failed vacuum-assisted extraction vs after a second-stage cesarean delivery without a trial of vacuum-assisted extraction. STUDY DESIGN This was a multicenter retrospective cohort study. The study population included all women in their subsequent pregnancy after a second-stage cesarean delivery who delivered in all university-affiliated obstetrical centers (n=4) in a single geographic area between 2003 and 2021. Maternal and neonatal outcomes of women who had second-stage cesarean delivery after a failed vacuum-assisted delivery were compared with women who had second-stage cesarean delivery without a trial of vacuum-assisted delivery. The primary outcome of this study was preterm delivery at <37 weeks of gestation. The secondary outcomes were vaginal birth rate and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. RESULTS During the study period, 1313 women met the inclusion criteria, of whom 215 (16.4%) had a history of failed vacuum-assisted delivery at the previous delivery and 1098 (83.6%) did not. In univariate analysis, women with previously failed vacuum-assisted delivery had similar preterm delivery rates (<37, <34, <32, and <28 weeks of gestation), a successful trial of labor after cesarean delivery rates, uterine rupture, and hysterectomy. However, multivariable analyses controlling for confounders showed that a history of failed vacuum-assisted delivery is associated with a higher risk of preterm delivery at <37 weeks of gestation (adjusted odds ratio, 2.05; 95% confidence interval, 1.11-3.79; P=.02), but not with preterm delivery at <34 or <32 weeks of gestation. CONCLUSION Among women with a previous second-stage cesarean delivery, previously failed vacuum-assisted delivery was associated with an increased risk of preterm delivery at <37 weeks of gestation in the subsequent birth.
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Affiliation(s)
- Maayan Blum
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Hila Hochler
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom).
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Tzuria Peled
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Ori Ben-Zion
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Ari Weiss
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Michal Lipschuetz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom); Faculty of Medicine, Henrietta Szold Hadassah - Hebrew University School of Nursing, Jerusalem, Israel (Dr Lipschuetz)
| | - Joshua Isaac Rosenbloom
- Faculty of Medicine, Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel (Drs Hochler, Lipschuetz, and Rosenbloom)
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich)
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel (Drs Blum, Sela, Peled, Ben-Zion, Weiss, Grisaru-Granovsky, and Rottenstreich); Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel (Dr Rottenstreich)
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Romero S, Lindström K, Listermar J, Westgren M, Ajne G. Long-term neurodevelopmental outcome in children born after vacuum-assisted delivery compared with second-stage caesarean delivery and spontaneous vaginal delivery: a cohort study. BMJ Paediatr Open 2023; 7:e002048. [PMID: 37848264 PMCID: PMC10582903 DOI: 10.1136/bmjpo-2023-002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To evaluate long-term neurodevelopment in children born after low-or mid-station vacuum-assisted delivery (VAD) compared with children delivered by second-stage caesarean delivery (SSCD) or spontaneous vaginal delivery (SVD). DESIGN Cross-sectional cohort study. SETTING Two delivery wards, Karolinska University Hospital, Sweden. PATIENTS 253 children born by low-station or mid-station VAD, 247 children born after an SVD, and 86 children born via an SSCD accepted to participate. INTERVENTIONS The Five-to-Fifteen questionnaire was used as a validated screening method for neurodevelopmental difficulties, assessed by parents. MAIN OUTCOMES MEASURES Results in the Five-to-Fifteen questionnaire. In addition, registered neurodevelopmental ICD-10 diagnoses were collected. Regression analyses estimated associations between delivery modes. RESULTS Children born after VAD exhibited an increased rate of long-term neurodevelopmental difficulties in motor skills (OR 2.2, 95% CI 1.3 to 3.8) and perception (OR 1.7, 95% CI 1.002 to 2.9) compared with SVD. Similar findings were seen in the group delivered with an SSCD compared with SVD (motor skills: OR 3.3, 95% CI 1.8 to 6.4 and perception: OR 2.3, 95% CI 1.2 to 4.4). The increased odds for motor skills difficulties after VAD and SSCD remained after adjusting for proposed confounding variables. There were significantly more children in the VAD group with registered neurodevelopmental ICD-10 diagnoses such as attention deficit/hyperactivity disorders. CONCLUSIONS The differences in long-term neurodevelopmental difficulties in children delivered with a VAD or SSCD compared with SVD in this study indicate the need for increased knowledge in the field to optimise the management of second stage of labour.
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Affiliation(s)
- Stefhanie Romero
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
- Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Lindström
- Neuropaediatrics, Karolinska University Hospital, Stockholm, Sweden
- Division of Paediatrics, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
| | | | - Magnus Westgren
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
| | - Gunilla Ajne
- Division of Obstetrics and Gynaecology, Karolinska Institute Department of Clinical Science Intervention and Technology, Huddinge, Sweden
- Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
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9
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Monje SJ, Gimovsky AC. Neonatal outcomes after vacuum-assisted cesarean delivery in a contemporary cohort. J Perinatol 2023; 43:1319-1320. [PMID: 37076736 DOI: 10.1038/s41372-023-01676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Silas J Monje
- The Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Alexis C Gimovsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA
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10
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Kong CW, To WWK, Lai THT, Tang EWH, Ho YC, Li KKW. A prospective study on neonatal ophthalmic injuries associated with forceps delivery. J AAPOS 2023; 27:196.e1-196.e5. [PMID: 37453665 DOI: 10.1016/j.jaapos.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/23/2023] [Accepted: 04/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery. METHODS Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively. Ophthalmologists would be consulted when there were signs of external ophthalmic injuries, such as periorbital forceps marks or facial bruising. Demographic data, pregnancy characteristics, delivery details, and perinatal outcomes were evaluated to identify any associated risk factors for neonatal ophthalmological injuries. RESULTS A total of 77 forceps deliveries were performed in the study period, in which 20 cases (26%) required ophthalmological consultations. There were more right or left occipital fetal head positions in the group requiring ophthalmological assessment than those that did not require assessment (35% vs 12.3% [P = 0.023]). The degree of moulding of the fetal head was more marked in the former group (65% vs 28% [P = 0.001]). The overall incidence of detectable ophthalmological lesions was 16.9% (13/77). All ophthalmic injuries were mild, and most resolved with conservative management. CONCLUSIONS In our study cohort, external ophthalmic injuries were common after forceps delivery. We recommended ophthalmological consultation in newborns delivered by forceps with evidence of compressive trauma to rule out serious ophthalmological trauma.
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Affiliation(s)
- Choi Wah Kong
- Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong.
| | - William Wing Kee To
- Department of Obstetrics & Gynaecology, United Christian Hospital, Hong Kong
| | | | | | - Yok Chiu Ho
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong
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Panelli DM, Leonard SA, Joudi N, Judy AE, Bianco K, Gilbert WM, Main EK, El-Sayed YY, Lyell DJ. Clinical and Physician Factors Associated With Failed Operative Vaginal Delivery. Obstet Gynecol 2023; 141:1181-1189. [PMID: 37141591 PMCID: PMC10440297 DOI: 10.1097/aog.0000000000005181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/02/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To examine clinical and physician factors associated with failed operative vaginal delivery among individuals with nulliparous, term, singleton, vertex (NTSV) births. METHODS This was a retrospective cohort study of individuals with NTSV live births with an attempted operative vaginal delivery by a physician between 2016 and 2020 in California. The primary outcome was cesarean birth after failed operative vaginal delivery, identified using linked diagnosis codes, birth certificates, and physician licensing board data stratified by device type (vacuum or forceps). Clinical and physician-level exposures were selected a priori, defined using validated indices, and compared between successful and failed operative vaginal delivery attempts. Physician experience with operative vaginal delivery was estimated by calculating the number of operative vaginal delivery attempts made per physician during the study period. Multivariable mixed effects Poisson regression models with robust standard errors were used to estimate risk ratios of failed operative vaginal delivery for each exposure, adjusted for potential confounders. RESULTS Of 47,973 eligible operative vaginal delivery attempts, 93.2% used vacuum and 6.8% used forceps. Of all operative vaginal delivery attempts, 1,820 (3.8%) failed; the success rate was 97.3% for vacuum attempts and 82.4% for forceps attempts. Failed operative vaginal deliveries were more likely with older patient age, higher body mass index, obstructed labor, and neonatal birth weight more than 4,000 g. Between 2016 and 2020, physicians who attempted more operative vaginal deliveries were less likely to fail. When vacuum attempts were successful, physicians who conducted them had a median of 45 vacuum attempts during the study period, compared with 27 attempts when vacuum attempts were unsuccessful (adjusted risk ratio [aRR] 0.95, 95% CI 0.93-0.96). When forceps attempts were successful, physicians who conducted them had a median of 19 forceps attempts, compared with 11 attempts when forceps attempts were unsuccessful (aRR 0.76, 95% CI 0.64-0.91). CONCLUSION In this large, contemporary cohort with NTSV births, several clinical factors were associated with operative vaginal delivery failure. Physician experience was associated with operative vaginal delivery success, more notably for forceps attempts. These results may provide guidance for physician training in maintenance of operative vaginal delivery skills.
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Affiliation(s)
- Danielle M Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, the Department of Obstetrics and Gynecology, Sutter Medical Center, Sacramento, and the California Maternal Quality Care Collaborative, Palo Alto, California
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Zając K, Rybnik M, Kęsiak M, Kalinka J. Is There Still a Place for Forceps Delivery in Modern Obstetrics? J Mother Child 2023; 27:176-181. [PMID: 37920112 PMCID: PMC10623113 DOI: 10.34763/jmotherandchild.20232701.d-23-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/15/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Nowadays, we are witnessing a decrease of vaginal instrumental deliveries and continuous increase of caesarean section rate. However, proper identification of possibility of execution, indications for instrumental delivery and their skilful use may improve the broadly understood maternal and neonatal outcomes. The aim of this study is to present prevalence, risk factors, indications and outcomes of forceps deliveries among the patients at Department of Perinatology, Lodz. MATERIAL AND METHODS A retrospective study was conducted at the Department of Perinatology, Medical University of Lodz. The study included forceps deliveries carried out between January 2019 and December 2022. Total number of 147 cases were analysed in terms of indications for forceps delivery and maternal and neonatal outcomes such as vaginal - or cervical - laceration, postpartum haemorrhage, perineal tear, newborn injuries, Apgar score, umbilical cord blood gas analysis, NICU admission and cranial ultrasound scans. RESULTS The prevalence of forceps delivery was 2.2%. The most common indication for forceps delivery was foetal distress (81.6%). Among mothers, the most frequent complication was vaginal laceration (40.1%). Third-and fourth-degree perineal tears were not noted. Regarding neonatal outcomes, Apgar score ≥ 8 after 1st and 5th minute of life received accordingly 91.2% and 98% of newborns. Only 8.8% experienced severe birth injuries (subperiosteal haematoma, clavicle fracture). CONCLUSIONS Although foetal distress is the most common indication for forceps delivery, the vast majority of newborns were born in good condition and did not require admission to NICU. Taking into consideration high efficacy and low risk of neonatal and maternal complications, forceps should remain in modern obstetrics.
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Affiliation(s)
- Katarzyna Zając
- Department of Perinatology, Medical University of Lodz, Poland
| | - Małgorzata Rybnik
- Department of Neonatology and Intensive Neonatal Care, Pirogow Hospital, Lodz, Poland
| | - Marcin Kęsiak
- Department of Neonatology and Intensive Neonatal Care, Pirogow Hospital, Lodz, Poland
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La Russa R, Maiese A, Cipolloni L, Di Fazio N, Delogu G, De Matteis A, Del Fante Z, Manetti F, Frati P, Fineschi V. Diagnostic assessment of traumatic brain injury by vacuum extraction in newborns: overview on forensic perspectives and proposal of operating procedures. FRONT BIOSCI-LANDMRK 2022; 27:79. [PMID: 35345311 DOI: 10.31083/j.fbl2703079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 10/18/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) during birth constitutes one of the most relevant causes of mortality and morbidity in newborns worldwide. Although improvements in obstetrical management and better indications for caesarean section have led to a consistent decrease in the incidence of perinatal mechanical injury, vacuum extraction is still associated with a high complications rate leading to several forensic issues in the evaluation of healthcare professional management. METHODS Vacuum-associated lesions may be topographically distinguished as extracranial or intracranial injuries. In order to achieve a correct assessment, diagnostic procedure should include post-mortem computed tomography and magnetic resonance imaging, autopsy examination, brain sampling and histological/immunohistochemical examination. RESULTS Post-mortem imaging represents a valid aid to guarantee preliminary evidence and direct subsequent investigations. An appropriate autopsy sampling must include several areas of cortex and underlying white matter; moreover, any visceral hemorrhages or other lesions should be sampled for the histological and immunohistochemical assessment of vitality and timing. CONCLUSIONS This study aimed to promote a validated step-by-step procedure to be adopted in order to standardize and to make easier the post-mortem framing and timing of vacuum-associated pediatric brain injuries.
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Affiliation(s)
- Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Aniello Maiese
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Zoe Del Fante
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00161 Rome, Italy
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Korbeľ M, Krištúfková A, Adamec A, Vargová M, Kaščák P, Nižňanská Z. Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018. Ceska Gynekol 2022; 87:80-86. [PMID: 35667857 DOI: 10.48095/cccg202280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. METHODS The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. RESULTS Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. CONCLUSION The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.
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Sugulle M, Halldórsdóttir E, Kvile J, Berntzen LSD, Jacobsen AF. Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications. PLoS One 2021; 16:e0259926. [PMID: 34784382 PMCID: PMC8594828 DOI: 10.1371/journal.pone.0259926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/02/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. STUDY DESIGN Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. RESULTS Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p< 0.001). CONCLUSION In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.
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Affiliation(s)
- Meryam Sugulle
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Erna Halldórsdóttir
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Janne Kvile
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Division of Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Rizzo G, Mattioli C, Mappa I, Bitsadze V, Khizroeva J, Makatsariya A, D'Antonio F. Antepartum ultrasound prediction of failed vacuum-assisted operative delivery: a prospective cohort study. J Matern Fetal Neonatal Med 2021; 34:3323-3329. [PMID: 31718394 DOI: 10.1080/14767058.2019.1683540] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Failed vacuum-assisted delivery (VD) is associated with increased risk of maternal perineal trauma and neonatal morbidity. Knowledge of the risk factors related to failed VD is essential in the clinical decision-making. OBJECTIVE To elucidate the strength of association and the predictive accuracy of different ante-partum ultrasound parameters in predicting the risk of failed VD prior to the onset of Labor and to test the diagnostic performance of a multiparametric model including pregnancy and Labor characteristics, ante and intra-partum ultrasound in anticipating failed VD. STUDY DESIGN Prospective study of consecutive singleton pregnancies complicated by VD undergoing a dedicated ultrasound assessment at 36-38 weeks of gestation. Head circumference (HC), estimated fetal weight (EFW) and subpubic angle and (SPA) were recorded before the onset of Labor. At the time of the VD, occiput position, head perineum distance (HPD) and angle of progression (AOP) were also recorded. Multivariate logistic regression and area under the curve (AUC) analyses were used to explore the strength of association and test the diagnostic accuracy of different maternal, Labor and ultrasound characteristics in predicting g failed VD. RESULTS Four hundred eight pregnancies with successful and 26 with failed VD were included in the analysis. Fetuses experiencing failed VD had a larger HC (1.21 versus 1.07 MoM; p = .0001), a higher EFW z-value (0.56 versus 0.33 z values; p = .002) and a narrower SPA (114 versus 122 p = .0001) compared to those having a successful VD. At multivariable logistic regression analysis, maternal height (aOR 0.89 95% CI 0.76-0.98), nulliparity (aOR: 1.14 95% CI 1.06-1.36), HC MoM (aOR: 1.24 95% CI 1.13-1.55) and SPA angle (aOR: 0.82 95% CI 0.67-0.95), but not EFW (p = .08) were independently associated with failed VD. When intrapartum ultrasound variables were added to the multivariate model, fetal occipital position (aOR: 1.45 95th CI 1.11-1.99) and HPD (aOR: 0.77 95th CI 0.44-0.96) were independently associated with failed VD. A multiparametric model integrating pregnancy and Labor characteristics and ante-partum ultrasound variables had an AUC of 0.837 (95% CI 0.797-0.876) for the prediction of failed VE. The addition of intra-partum ultrasound variables to the prediction model, improved the accuracy for failed VD provided by maternal and antepartum ultrasound characteristics with an AUC of 0.913 (0.888-0.937). CONCLUSION Antepartum prediction of failed VD is feasible. HC, SPA but not EFW are independently associated and predictive of failed VD. Adding these variables to a multiparametric model including maternal and intrapartum ultrasound parameters improves the diagnostic accuracy for failed VD.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine Unit Ospedale Cristo Re, University of Rome "Tor Vergata", Roma, Italy
| | - Cecilia Mattioli
- Division of Maternal Fetal Medicine, Università Degli Studi di Roma Tor Vergata, Re Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Sechenov University, Moskva, Russia
| | - Viktoriya Bitsadze
- Department of Obstetrics and Gynecology, Sechenov University, Moskva, Russia
| | - Jamilya Khizroeva
- Department of Obstetrics and Gynecology, Sechenov University, Moskva, Russia
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Rottenstreich M, Rotem R. Response to: vacuum assisted vaginal birth after cesarean: the indication for vacuum assistance matters. Arch Gynecol Obstet 2021; 305:795. [PMID: 33871704 DOI: 10.1007/s00404-021-06035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 12 Bayit, 91031, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, 12 Bayit, 91031, Jerusalem, Israel.
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Bayih WA, Yitbarek GY, Aynalem YA, Abate BB, Tesfaw A, Ayalew MY, Belay DM, Hailemeskel HS, Alemu AY. Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia. BMC Pregnancy Childbirth 2020; 20:653. [PMID: 33115413 PMCID: PMC7594464 DOI: 10.1186/s12884-020-03348-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies. METHODS Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI. RESULTS The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI. CONCLUSIONS The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.
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Aust A, Arnold JJ. Antibiotic Prophylaxis for Operative Vaginal Delivery. Am Fam Physician 2020; 102:Online. [PMID: 32996760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Levin G, Friedman T, Shai D, Alcalay M, Ram E, Meyer R. The association between vacuum-assisted vaginal delivery and anal sphincter injury. Int Urogynecol J 2020; 32:1771-1777. [PMID: 32997160 DOI: 10.1007/s00192-020-04534-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Vacuum-assisted vaginal delivery (VAVD) is considered a major risk factor for obstetric anal sphincter injuries (OASIS). However, it is difficult to estimate its true contribution to the occurrence of OASIS, as its performance may be confounded by other determinants. Therefore, we aimed to evaluate the association of VAVD with OASIS among primiparous women compared to SVD. METHODS A retrospective cohort study including all primiparous women who vaginally delivered a cephalic singleton gestation during the years 2011 to 2020. As VAVDs were not performed before 34 gestational weeks, we capped the cohort at this gestational age. Women were allocated into two groups: VAVDs and spontaneous vaginal deliveries (SVD). We compared women with OASIS to those without and performed a multivariate analysis including factors that were found significant in the univariate analysis. We further divided the whole cohort into different subcategories. The primary outcome was the rate of OASIS in VAVD compared to SVD. RESULTS Overall, 23,272 primiparous vaginal deliveries were available for evaluation. Of these, 3595 delivered by VAVD and 19,677 delivered spontaneously. OASIS occurred in 421 (1.8%) of the deliveries. OASIS were more common in VAVDs than in SVDs [83 (2.3%) vs. 338 (1.7%), respectively, OR (95% CI) 1.35 (1.06-1.72), p = 0.01]. After multivariate regression analysis, OASIS were not found to be independently associated with the mode of delivery [aOR 1.21 (95% CI) 0.88-1.68, P = 0.23]. In a categorical analysis of OASIS rates by risk factors and mode of delivery, VAVD was not associated with an increase in OASIS among women giving birth to neonates weighing > 3500 g compared to SVD [OR (95% CI) 1.02 (0.65-1.62), P = 0.90]. CONCLUSION Among primiparous women VAVD did not increase the risk of OASIS compared to SVD.
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Affiliation(s)
- Gabriel Levin
- The Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Talia Friedman
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Shai
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Menachem Alcalay
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Department of Obstetrics and Gynecology, Urogynecology Unit, Baruch Padeh-Poria Medical Center, Tiberias, Israel, affiliated to The Faculty of Medicine at Galille, Bar Ilan University, Ramat Gan, Israel
| | - Edward Ram
- The Department of Surgery and Transplantation, the Chaim Sheba Medical Center, Ramat-Gan, Israel affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- The Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel, affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
BACKGROUND Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. This is an update of a review last published in 2017. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps delivery, or both. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (5 July 2019), and reference lists of retrieved studies. SELECTION CRITERIA All randomised controlled trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium). DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the two included studies using the GRADE approach. MAIN RESULTS Two studies, involving 3813 women undergoing either vacuum or forceps deliveries, were included. One study involving 393 women compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. The other study involving 3420 women compared a single dose of intravenous amoxicillin and clavulanic acid with placebo using 20 mL of intravenous sterile 0.9% saline. The evidence suggests that prophylactic antibiotics reduce superficial perineal wound infection (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.40 to 0.69; women = 3420; 1 study; high-certainty evidence), deep perineal wound infection (RR 0.46, 95% CI 0.31 to 0.69; women = 3420; 1 study; high-certainty evidence) and probably reduce wound breakdown (RR 0.52, 95% CI 0.43 to 0.63; women = 2593; 1 study; moderate-certainty evidence). We are unclear about the effect on organ or space perineal wound infection (RR 0.11, 95% CI 0.01 to 2.05; women = 3420; 1 study) and endometritis (average RR 0.32, 95% CI 0.04 to 2.64; 15/1907 versus 30/1906; women = 3813; 2 studies) based on low-certainty evidence with wide CIs that include no effect. Prophylactic antibiotics probably lower serious infectious complications (RR 0.44, 95% CI 0.22 to 0.89; women = 3420; 1 study; high-certainty evidence). They also have an important effect on reduction of confirmed or suspected maternal infection. The two included studies did not report on fever or urinary tract infection. It is unclear, based on low-certainty evidence, whether prophylactic antibiotics have any impact on maternal adverse reactions (RR 2.00, 95% CI 0.18 to 22.05; women = 2593; 1 study) and maternal length of stay (MD 0.09 days, 95% CI -0.23 to 0.41; women = 393; 1 study) as the CIs were wide and included no effect. Prophylactic antibiotics slightly improve perineal pain and health consequences of perineal pain and probably reduce costs. Prophylactic antibiotics did not have an important effect on dyspareunia (difficult or painful sexual intercourse) or breastfeeding at six weeks. Antibiotic prophylaxis may slightly improve maternal hospital re-admission and maternal health-related quality of life. Neonatal adverse reactions were not reported in any included trials. AUTHORS' CONCLUSIONS Prophylactic intravenous antibiotics are effective in reducing infectious puerperal morbidities in terms of superficial and deep perineal wound infection or serious infectious complications in women undergoing operative vaginal deliveries without clinical indications for antibiotic administration after delivery. Prophylactic antibiotics slightly improve perineal pain and health consequences of perineal pain, probably reduce the costs, and may slightly reduce the maternal hospital re-admission and health-related quality of life. However, the effect on reduction of endometritis, organ or space perineal wound infection, maternal adverse reactions and maternal length of stay is unclear due to low-certainty evidence. As the evidence was mainly derived from a single multi-centre study conducted in a high-income setting, future well-designed randomised trials in other settings, particularly in low- and middle-income settings, are required to confirm the effect of antibiotic prophylaxis for operative vaginal delivery.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Prince of Songkla UniversityEpidemiology Unit, Faculty of MedicineHat YaiSongkhlaThailand90110
| | - Thanapan Choobun
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiSongkhlaThailand90110
| | - Krantarat Peeyananjarassri
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiSongkhlaThailand90110
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García-Mejido JA, Martín-Martínez A, González-Diaz E, Fernández-Fernández C, Ortega I, Medina M, Fernández-Corona A, Fernández-Palacín A, Sainz JA. Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor? Ultrasound Obstet Gynecol 2020; 55:257-263. [PMID: 31332857 DOI: 10.1002/uog.20404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J A García-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
| | - A Martín-Martínez
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - E González-Diaz
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - C Fernández-Fernández
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - I Ortega
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - M Medina
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Gran Canarias, Gran Canarias, Spain
| | - A Fernández-Corona
- Department of Obstetrics and Gynecology, Complejo Asistencial Universitario de Leon (CAULE), Leon, Spain
| | - A Fernández-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain
| | - J A Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Biru S, Addisu D, Kassa S, Animen S. Maternal complication related to instrumental delivery at Felege Hiwot Specialized Hospital, Northwest Ethiopia: a retrospective cross-sectional study. BMC Res Notes 2019; 12:482. [PMID: 31382987 PMCID: PMC6683480 DOI: 10.1186/s13104-019-4530-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study aimed to determine proportion and risk factors for maternal complication related to forceps and vacuum delivery among mother who gave birth at Felege Hiwot Comprehensive Specialized Hospital (FHCSH). RESULTS Records of 406 mothers managed with instrumental vaginal delivery were reviewed and 97% of the reviewed card had complete documentation. The proportion of maternal complications related to instrumental delivery was 12.1%. A major complication of forceps assisted delivery was 2nd-degree perineal tear (7.4%), 3rd-degree perineal tear (1.5%), cervical tear (1.5%) and episiotomy extension (1%). However, the complication of vacuum-assisted vaginal delivery was only cervical tear (0.5%) and episiotomy extension (0.5%). Episiotomy during instrumental delivery reduce maternal complication by 86% [AOR = 0.14, 95% CI 0.07-0.3]. Forceps assisted vaginal delivery had 3.4 times more risk for maternal complication compared to vacuum-assisted vaginal delivery [AOR = 3.4, 95% CI 1.08-10.67] and the same is true for primiparity that primipara women who gave birth by the help of instrument had 3.5 times more risk for maternal complication compared to a multipara women [AOR = 3.5, 95% CI 1.26-9.98].
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Affiliation(s)
- Shimeles Biru
- Department of Midwifery, College Of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dagne Addisu
- Department of Midwifery, College Of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simachew Kassa
- Department of Midwifery, College Of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Simachew Animen
- Department of Midwifery, College Of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Morávková P, Hruban L, Jančářová D, Janků P, Gerychová R, Vinklerová P, Štěpánová R, Ventruba P. Operative vaginal deliveries and their impact on maternal and neonatal outcomes - prospective analysis. Ceska Gynekol 2019; 84:93-98. [PMID: 31238678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis. DESIGN Prospective case-control study analysis. SETTING Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed. RESULTS In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%). CONCLUSION The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.
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Weissbach T, Hag-Yahia N, Ovadia M, Tzadikevitch Geffen K, Weitzner O, Biron-Shental T. Kiwi omnicup handheld versus Mityvac M-style conventional vacuum system: a retrospective observational study. J Matern Fetal Neonatal Med 2018; 31:3178-3182. [PMID: 28793827 DOI: 10.1080/14767058.2017.1366443] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To improve the choice of vacuum-assisted delivery (VAD) system, we compared the outcomes of Kiwi handheld system and Mityvac M-style conventional system (both use disposable plastic cups). MATERIALS AND METHODS Retrospective observational study with data collection from electronic medical records. The study was conducted at a tertiary medical center, with approximately 7000 deliveries annually. Categorical and continuous variables were analyzed using chi-square test and t-test, respectively. p value < .05 was considered significant. The main outcomes assessed were the overall failure rate of each system, failure rates for occipito-anterior (OA) versus occipito-transverse/occipito-anterior (OT/OP) positions, +1 versus +2 fetal stations, and early maternal/neonatal outcomes. RESULTS During a 10-month period, there were 507 (8.4%) attempted VADs, 36 failed (7.1%), and eight (1.5%) converted to cesarean section. Of these, 364 were Kiwi-assisted and 143 Mityvac-assisted. Background characteristics were similar. The handheld system had more failures overall (9.6 versus 0.7%), at OA (7.6 versus 0.9%), and non-OA positions (17.3% versus none), at +1 (13.25 versus 0.96%) and at +2/3 stations (6.1% versus none), than the conventional system did, respectively. There was a higher rate of early post-partum hemorrhage (15.3 versus 7.4%) in the conventional group. Both systems had similar rates of third/fourth degree perineal tears, shoulder dystocia and adverse neonatal outcomes. CONCLUSIONS Our results suggest more failures with Kiwi compared to Mityvac, overall and at any fetal position/station, without a significant difference in adverse outcome profile.
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Affiliation(s)
- Tal Weissbach
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nasreen Hag-Yahia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michal Ovadia
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Keren Tzadikevitch Geffen
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Omer Weitzner
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Tal Biron-Shental
- a Department of Obstetrics and Gynecology , Meir Medical Center , Kfar Saba , Israel
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Ghi T, Dall'Asta A, Masturzo B, Tassis B, Martinelli M, Volpe N, Prefumo F, Rizzo G, Pilu G, Cariello L, Sabbioni L, Morselli-Labate AM, Todros T, Frusca T. Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.). Ultrasound Obstet Gynecol 2018; 52:699-705. [PMID: 29785716 DOI: 10.1002/uog.19091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. METHODS Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. RESULTS On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. CONCLUSIONS Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - B Masturzo
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - B Tassis
- Department of Obstetrics and Gynecology, Mangiagalli University Hospital, Milan, Italy
| | - M Martinelli
- Department of Obstetrics and Gynecology, Fatebenefratelli San Peter Hospital, Rome, Italy
| | - N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - L Cariello
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - L Sabbioni
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A M Morselli-Labate
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Wang JF, Lederhandler MH, Oza VS. Escherichia coli-infected cephalohematoma in an infant. Dermatol Online J 2018; 24:13030/qt456083v1. [PMID: 30695981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023] Open
Abstract
We report a case of Escherichia coli infection of a cephalohematoma in an infant delivered by vacuum extraction. After excluding potential complications, the patient was treated with intravenous ceftriaxone while hospitalized followed by oral cephalexin after discharge. Infection is a rare but serious complication of cephalohematomas in the newborn period. Escherichia coli is the most common pathogen responsible for infected cephalohematomas. Clinicians should be aware that infected cephalohematomas may be complicated by sepsis, meningitis, or osteomyelitis.
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Affiliation(s)
| | | | - Vikash S Oza
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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Bourgon N, Mottet N, Bourtembourg A, Pugin A, Ramanah R, Riethmuller D. [Obstetrical anal sphincter injuries and vacuum-assisted delivery at term in primiparas]. ACTA ACUST UNITED AC 2018; 46:686-691. [PMID: 30293947 DOI: 10.1016/j.gofs.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Operative Vaginal Delivery (OVD) is subject to a risk of perineal tears especially of Obstetrical Anal Sphincter Injuries (OASIS) that are associated with more complications and impaired quality of life. The main objective of this study was to compare the rate of OASIS in primipara at term with fetus in cephalic presentation depending on the type of delivery: OVD using vacuum extractor and spontaneous delivery. METHODS This is a single-center retrospective study between 01/01/2010 and 12/31/2014 including all primipara who delivered vaginally at term, a single and living fetus in cephalic presentation. Perineal lesions were classified according to the WHO classification. The primary endpoint was the proportion of OASIS. RESULTS 3552 patients were included: 2496 spontaneous deliveries (SD) and 1056 OVD (29.72 %). There were twenty sphincter tears (0.56 %): 7 in SD group (0.28 %) and 13 in OVD (1.23 %), P<0.0001, OR=5.10 [2.00; 12.99]. Other risk factors associated with OASIS in univariable analysis were: maternal age (≥30 years), duration of expulsive efforts (≥20min) and a birth weight≥4000g. CONCLUSION In these patients, the risk of OASIS in case of AI increases by a factor of 5;10. The high rate of AI in these patients exposes them to a real risk of OASIS. However, the proportion of OASIS in this group remains lower than those reported in the literature and is barely higher than the national overall rate, despite a very restrictive policy of the use of episiotomy.
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Affiliation(s)
- N Bourgon
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - N Mottet
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Bourtembourg
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - A Pugin
- Centre d'investigation clinique, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - R Ramanah
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France
| | - D Riethmuller
- Pôle Mère-Femme, CHRU Besançon, 3, boulevard Fleming, 25000 Besançon, France.
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Affiliation(s)
- Jonathan J Lee
- Division of Craniofacial Medicine Department of Pediatrics Seattle Children's Hospital Seattle, Washington
| | - Tara L Wenger
- Division of Craniofacial Medicine Department of Pediatrics Seattle Children's Hospital Seattle, Washington
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O’Malley D, Higgins A, Begley C, Daly D, Smith V. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 2018; 18:196. [PMID: 29855357 PMCID: PMC5984394 DOI: 10.1186/s12884-018-1838-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum. METHODS A longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors. RESULTS Nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum. CONCLUSION Breastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.
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Affiliation(s)
- Deirdre O’Malley
- Health Research Board, Research Fellow, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Abstract
BACKGROUND Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies. SELECTION CRITERIA All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach. MAIN RESULTS One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay. AUTHORS' CONCLUSIONS One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
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Affiliation(s)
| | - Thanapan Choobun
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiThailand90110
| | - Krantarat Peeyananjarassri
- Prince of Songkla UniversityDepartment of Obstetrics and Gynecology, Faculty of MedicineHat YaiThailand90110
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Salman L, Aviram A, Krispin E, Wiznitzer A, Chen R, Gabbay-Benziv R. Adverse neonatal and maternal outcome following vacuum-assisted vaginal delivery: does indication matter? Arch Gynecol Obstet 2017; 295:1145-1150. [PMID: 28324223 DOI: 10.1007/s00404-017-4339-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/28/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the impact of indication for vacuum-assisted vaginal delivery on neonatal and maternal adverse outcome. METHODS Retrospective analysis of women carrying singleton-term pregnancies undergoing vacuum-assisted vaginal delivery in a tertiary hospital (2007-2014). Cohort was stratified by indication: non-reassuring fetal heart rate or prolonged second stage. Primary outcome was adverse neonatal outcome and secondary outcome was maternal morbidity. Logistic regression analysis was utilized to adjust for potential confounders. RESULT Overall, 4931 women met inclusion criteria. Delivery indication was prolonged second stage in 3143 (64%) cases and non-reassuring fetal heart rate in 1788 (36%). In the non-reassuring fetal heart rate group, there were higher rates of cephalohematoma, low 5-min Apgar-score, and asphyxia. In the prolonged second-stage group, there were higher rates of sepsis and post-partum hemorrhage. Composite neonatal birth trauma and maternal morbidity were higher for vacuum-assisted vaginal delivery following prolonged second stage. Following adjustment for confounders cephalohematoma (aOR 1.21, 95% CI 1.04-1.41), low 5-min Apgar-score (aOR 2.91, 95% CI 1.26-4.67) and asphyxia (aOR 1.81 95% CI 1.35-2.44) remained significant in the non-reassuring fetal heart rate group and neonatal sepsis remained significant for the prolonged second-stage group (aOR 1.77, 95% CI 1.38-2.27), p < 0.05 for all. However, there was no longer difference in the composite birth trauma, other neonatal or maternal morbidity. CONCLUSION The indication for vacuum-assisted vaginal delivery has an impact on neonatal outcome. While cephalohematoma, low 5' Apgar score, and asphyxia were more common in the non-reassuring fetal heart rate group, neonatal sepsis was more common in cases of prolonged second stage of labor.
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Affiliation(s)
- Lina Salman
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Aviram
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Krispin
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rony Chen
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Gabbay-Benziv
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, 49100, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Pettersson K, Yousaf K, Ranstam J, Westgren M, Ajne G. Predictive value of traction force measurement in vacuum extraction: Development of a multivariate prognostic model. PLoS One 2017; 12:e0171938. [PMID: 28257459 PMCID: PMC5336195 DOI: 10.1371/journal.pone.0171938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/29/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To enable early prediction of strong traction force vacuum extraction. DESIGN Observational cohort. SETTING Karolinska University Hospital delivery ward, tertiary unit. POPULATION AND SAMPLE SIZE Term mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277. METHODS Traction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction. STATISTICAL ANALYSIS A logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables. PREDICTORS Total (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull. OUTCOME Subjectively categorized extraction as strong versus non-strong. RESULTS The prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89. CONCLUSION Traction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
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Affiliation(s)
- Kristina Pettersson
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Khurram Yousaf
- Clintec, Karolinska Institute, Stockholm, Sweden
- School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Jonas Ranstam
- Statistician, Swedish Patient Insurance, Stockholm, Sweden
| | - Magnus Westgren
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
| | - Gunilla Ajne
- Obstetrics and gynecology, Karolinska University Hospital, Stockholm, Sweden
- Clintec, Karolinska Institute, Stockholm, Sweden
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Huhn EA, Visca E, Vogt DR, von Felten S, Tinner Oehler EM, Bührer C, Surbek D, Zimmermann R, Hoesli I. Decreased neonatal pain response after vaginal-operative delivery with Kiwi OmniCup versus metal ventouse. BMC Pregnancy Childbirth 2017; 17:47. [PMID: 28143599 PMCID: PMC5282794 DOI: 10.1186/s12884-017-1231-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaginal delivery, especially operative assisted vaginal delivery, seems to be a major stressor for the neonate. The objective of this study was to evaluate the stress response after metal cup versus Kiwi Omnicup® ventouse delivery. METHODS The study was a secondary observational analysis of data from a former prospective randomised placebo controlled multicentre study on the analgesic effect of acetaminophen in neonates after operative vaginal delivery and took place at three Swiss tertiary hospitals. Healthy pregnant women ≥35 weeks of gestation with an estimated fetal birth weight above 2000 g were recruited after admission to the labour ward. Pain reaction was analysed by pain expression score EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) directly after delivery. For measurement of the biochemical stress response, salivary cortisol as well as the Bernese Pain Scale of Newborns (BPSN) were evaluated before and after an acute pain stimulus (the standard heel prick for metabolic testing (Guthrie test)) at 48-72 h. RESULTS Infants born by vaginal operative delivery displayed a lower pain response after plastic cup than metal cup ventouse delivery (p < 0.001), but the pain response was generally lower than expected and they recovered fully within 72 h. CONCLUSIONS Neonatal pain response is slightly reduced after use of Kiwi OmniCup® versus metal cup ventouse. TRIAL REGISTRATION Trial was registered under under NCT00488540 on 19th June 2007.
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Affiliation(s)
- E A Huhn
- Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - E Visca
- Department of Obstetrics and Gynaecology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - D R Vogt
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - S von Felten
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - E M Tinner Oehler
- Department of Paediatrics, Insel Hospital, University of Bern, Bern, Switzerland
| | - C Bührer
- Department of Neonatology, Charité University Medical Center, Berlin, Germany
| | - D Surbek
- Department of Obstetrics and Gynaecology, Insel Hospital, University of Bern, Bern, Switzerland
| | - R Zimmermann
- Department of Obstetrics and Gynaecology, University Hospital Zurich, Zurich, Switzerland
| | - I Hoesli
- Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
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Kacvinska A, Drab M, Totka A, Holoman K, Gabor M. The effect of prostaglandin induced labor and selected factors on the occurrence and extent of birth-canal injuries. BRATISL MED J 2016; 117:511-514. [PMID: 27677194 DOI: 10.4149/bll_2016_099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine the effect of labor induction using prostaglandin, gestation period and delivery type on the cause and extent of birth-canal injuries. METHODS A retrospective study based on the records of II. GPK UNB Ružinov. The total set (n = 1377) consisted of patients who went into labor in second half of the year 2014 at this clinic. The research used categorical data divided into groups of factors (induction, week of delivery, type of delivery) and birth injuries. Using the chi-square test and Fisher's test we evaluated individual statistical dependences. The results with the highest level of significance are expressed through contingency tests (Phi coefficient, contingency coefficient, Cramer's V). Finally, because of the highest level of significance we have done a cohort study to express the incidence of relationship between non-operative delivery per vaginam and 1st degree ruptura perieni. RESULTS Labor induction with prostaglandins has a positive impact on the cause and extent of birth-canal injuries, namely the increased risk of vaginal walls tearing and uterine ruptures. We confirmed that the induction of labor using PG carries a demonstrable risk of pregnancy termination by cesarean section (p = 6.17x10-9). Birth-canal injuries are also affected by the type of delivery. Non-operative vaginal delivery is a significant risk factor for first-degree perineal tear (RR = 25.52 95% CI 10.58, 61.60, OR = 33.06 95% CI 13.51, 80.90). Significant risk factors for third-grade perineal tear during vaginal delivery are forceps (p = 0.005534) / vacuum extractor (p = 0.03554). CONCLUSION In a group of 1377 patients we have demonstrated that the labor induction with prostaglandins, gestation period and type of delivery significantly influence the occurrence and extent of birth-canal injuries (Tab. 3, Ref. 9).
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Nolens B, Lule J, Namiiro F, van Roosmalen J, Byamugisha J. Audit of a program to increase the use of vacuum extraction in Mulago Hospital, Uganda. BMC Pregnancy Childbirth 2016; 16:258. [PMID: 27590680 PMCID: PMC5010743 DOI: 10.1186/s12884-016-1052-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prolonged second stage of labour is a major cause of perinatal and maternal morbidity and mortality in low-income countries. Vacuum extraction is a proven effective intervention, hardly used in Africa. Many authors and organisations recommend (re)introduction of vacuum extraction, but successful implementation has not been reported. In 2012, a program to increase the use of vacuum extraction was implemented in Mulago Hospital, Uganda. The program consisted of development of a vacuum extraction guideline, supply of equipment and training of staff. The objective of this study was to investigate the impact of the program. METHODS Audit of a quality improvement intervention with before and after measurement of outcome parameters. SETTING Mulago Hospital, the national referral hospital for Uganda with approximately 33 000 deliveries per year. It is the university teaching hospital for Makerere University and most of the countries doctors and midwives are trained here. Data was collected from hospital registers and medical files for a period of two years. Main outcome measures were vacuum extraction rate, intrapartum stillbirth, neonatal death, uterine rupture, maternal death and decision to delivery interval. RESULTS Mode of delivery and outcome of 12 143 deliveries before and 34 894 deliveries after implementation of the program were analysed. The vacuum extraction rate increased from 0.6 - 2.4 % of deliveries (p < 0.01) and was still rising after 18 months. There was a decline in intrapartum stillbirths from 34 to 26 per 1000 births (-23.6 %, p < 0.01) and women with uterine rupture from 1.1 - 0.8 per 100 births (-25.5 %, p < 0.01). Decision to delivery interval for vacuum extraction was four hours shorter than for caesarean section. CONCLUSIONS A program to increase the use of vacuum extraction was successful in a high-volume university hospital in sub-Saharan Africa. The use of vacuum extraction increased. An association with improved maternal and perinatal outcome is strongly suggested. We recommend broad implementation of vacuum extraction, whereby university hospitals like Mulago Hospital can play an important role.To support implementation, we recommend further research into outcome of vacuum extraction and into vacuum extraction devices for low-income countries. Such studies are now in progress at Mulago Hospital.
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Affiliation(s)
- Barbara Nolens
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, PO Box 7051, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, PO Box 9015, 6500GS Nijmegen, The Netherlands
- Athena Institute, VU University, PO Box 22700, 1100DE Amsterdam, The Netherlands
| | - John Lule
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, PO Box 7051, Kampala, Uganda
- Makerere University, School of Medicine, College of Health Sciences, PO Box 7072, Kampala, Uganda
| | - Flavia Namiiro
- Department of Paediatrics, Mulago National Referral Hospital, PO Box 7051, Kampala, Uganda
| | - Jos van Roosmalen
- Athena Institute, VU University, PO Box 22700, 1100DE Amsterdam, The Netherlands
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, PO Box 7051, Kampala, Uganda
- Makerere University, School of Medicine, College of Health Sciences, PO Box 7072, Kampala, Uganda
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Bultez T, Quibel T, Bouhanna P, Popowski T, Resche-Rigon M, Rozenberg P. Angle of fetal head progression measured using transperineal ultrasound as a predictive factor of vacuum extraction failure. Ultrasound Obstet Gynecol 2016; 48:86-91. [PMID: 26183426 DOI: 10.1002/uog.14951] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/04/2015] [Accepted: 07/13/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the predictive value of angle of progression (AoP) of the fetal head for a failed vacuum delivery. METHODS This was a prospective observational study that included women with a singleton pregnancy of ≥ 37 weeks' gestation, in cephalic presentation requiring vacuum extraction. Transperineal ultrasound was performed immediately before vacuum extraction, although AoP was measured on stored images after delivery. Vacuum extraction was defined as failed when the duration of extraction exceeded 20 min or the vacuum cup detached more than three times. We compared the demographic and ultrasound data of failed vacuum deliveries with those that were successful. The predictive value of AoP for failure of vacuum delivery was calculated. RESULTS AoP was measured in 235 women. Vacuum extractions failed in 30 (12.8%) women (29/184 nulliparous and 1/51 parous) and resulted in 28 vaginal deliveries by forceps and two Cesarean deliveries. Median AoP was significantly lower in the vacuum failure group compared with those with successful vacuum delivery (136.6° (interquartile range (IQR), 129.8-144.1°) vs 145.9° (IQR, 135.0-158.4°); P < 0.01). As all but one failed vacuum extraction occurred among nulliparous women, the predictive value of AoP was calculated in this subgroup of women. The area under the receiver-operating characteristics curve for prediction of vacuum extraction failure was 0.67 (95% CI, 0.57-0.77) and the optimal AoP cut-off was 145.5°. Above this value, the rate of vacuum extraction failure fell below 5%. CONCLUSION AoP is a predictive factor of failed vacuum extraction, especially among nulliparous women whose risk of failure is high. AoP measurement may help in choosing between forceps and vacuum extraction. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Bultez
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - T Quibel
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - P Bouhanna
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - T Popowski
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - M Resche-Rigon
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
- Department of Biostatistics, Saint-Louis Hospital, UMR-S 717 Paris Diderot University, Paris, France
| | - P Rozenberg
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
- Versailles-Saint-Quentin University, Research Unit EA 7285, Versailles, France
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Bailit JL, Grobman WA, Rice MM, Wapner RJ, Reddy UM, Varner MW, Thorp JM, Caritis SN, Iams JD, Saade G, Rouse DJ, Tolosa JE. Evaluation of delivery options for second-stage events. Am J Obstet Gynecol 2016; 214:638.e1-638.e10. [PMID: 26596236 DOI: 10.1016/j.ajog.2015.11.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery vs cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean vs operative vaginal delivery. OBJECTIVE Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps vs cesarean delivery) in patients needing second-stage assistance at a fetal station of +2 or below. STUDY DESIGN We conducted secondary analysis of an observational obstetric cohort in 25 academically affiliated US hospitals over a 3-year period. A subset of ≥37 weeks, nonanomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, nonreassuring fetal status, labor dystocia, or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother's, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third- and fourth-degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the 3 attempted modes of delivery. Odds ratios (OR) were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. RESULTS In all, 2531 women met inclusion criteria. No difference in the neonatal composite outcome was observed between groups. Vacuum attempt was associated with the lowest frequency of maternal complications (postpartum infection 0.2% vs 0.9% forceps vs 5.3% cesarean, postpartum hemorrhage 1.4% vs 2.8% forceps vs 3.8% cesarean), except for severe lacerations (19.1% vs 33.8% forceps vs 0% cesarean). When confounders were taken into account, both forceps (OR, 0.16; 95% confidence interval, 0.05-0.49) and vacuum (OR, 0.04; 95% confidence interval, 0.01-0.17) were associated with a significantly lower odds of postpartum infection. The neonatal composite and postpartum hemorrhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P = .04). CONCLUSION In patients needing second-stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of postpartum infection, but higher frequency of severe lacerations.
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Affiliation(s)
- Jennifer L Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
| | - William A Grobman
- Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Chicago, IL
| | - Madeline Murguia Rice
- Department of Obstetrics and Gynecology, George Washington University Biostatistics Center, Washington, DC
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, NY
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Michael W Varner
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Steve N Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Jay D Iams
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, RI
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
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Volløyhaug I, Mørkved S, Salvesen Ø, Salvesen KÅ. Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery. Ultrasound Obstet Gynecol 2015; 46:487-495. [PMID: 25920322 DOI: 10.1002/uog.14891] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. METHODS This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. RESULTS Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. CONCLUSIONS We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery.
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Affiliation(s)
- I Volløyhaug
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, Trondheim University Hospital, Trondheim, Norway
| | - S Mørkved
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Service, Trondheim University Hospital, Trondheim, Norway
| | - Ø Salvesen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Fetal Medicine, Trondheim University Hospital, Trondheim, Norway
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Marcovici I. Aplasia cutis congenita presenting as vacuum-extractor-related trauma. Int J Gynaecol Obstet 2015; 129:267-8. [PMID: 25754144 DOI: 10.1016/j.ijgo.2014.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/20/2014] [Accepted: 02/20/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Iacob Marcovici
- Department of Obstetrics and Gynecology, McLeod-Dillon, Dillon, SC, USA.
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Michalec I, Navrátilová M, Tomanová M, Kacerovský M, Šalounová D, Procházka M, Šimetka O. [Vacuum-assisted vaginal delivery does not significantly contribute to the higher incidence of levator ani avulsion]. Ceska Gynekol 2015; 80:37-41. [PMID: 25723077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To draw a comparison between spontaneous vaginal delivery and vacuum-assisted vaginal delivery in relation to the incidence and the type of levator ani avulsion in primiparas. DESIGN Retrospective observational study. SETTIMG: Department of Obstetrics and Gynaecology, University Hospital of Ostrava. METHODOLOGY In the study, the primiparas who were from 6 to 12 months after spontaneous vaginal delivery (group A, n = 52) or after childbirth with vacuum extraction (group B, n = 51) underwent translabial 3D ultrasound. The obstetric data had been obtained from the hospital database. Translabial 3D ultrasound examination were performed by two sonographists. The monitored parameter was the distance between urethra and fibres of musculus levator ani - levator urethra gap [6]. The distance longer than 25 mm was considered an avulsion injury [6, 22]. Other parameters assessed in relation to the avulsion were: women's age, BMI, epidural analgesia, episiotomy performance, the length of the first and the second stages of labour, and fetal weight. RESULTS Musculus levator ani avulsion was diagnosed in 10 women - unilateral in 8 cases and bilateral in 2 cases. In group A, women after spontaneous birth, we noticed avulsion injury in 7.7% of cases, whereas in group B, women after vacuum extraction, we recorded avulsion injury in 11.8% of cases. Thus the use of vacuum extraction is not statistically significant risk factor for avulsion musculus levator ani. Statistically significant difference in comparison group A and B was recorded in BMI, the length of the second stages of labour and episiotomy performance. CONCLUSION We did not prove a statistically significant connection between avulsion injury and delivery with the use of vacuum extraction in comparison to avulsion injury incidence in uncomplicated vaginal delivery group (tab. 1). Vacuum extraction does not appear as a risk factor for avulsion in contrast to forceps delivery.
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Abstract
BACKGROUND Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014). SELECTION CRITERIA All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. For this update, we assessed methodological quality of the one included trial using the standard Cochrane criteria and the GRADE approach. We calculated the risk ratio (RR) and mean difference (MD) using a fixed-effect model and all the review authors interpreted and discussed the results. MAIN RESULTS One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41). Overall, the risk of bias was judged as low. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay. AUTHORS' CONCLUSIONS The data were too few to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
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Affiliation(s)
- Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, 90110
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Maagaard M, Hedegaard M. [Vacuum extraction as treatment must be preserved, but requires increased competence]. Ugeskr Laeger 2013; 175:32. [PMID: 23305635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Thorup L, Koch KU. [Neonatal subgaleal haemorrhage causing fatal course after vacuum-assisted extraction]. Ugeskr Laeger 2013; 175:34-35. [PMID: 23305636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We present a case that emphasizes the importance of early recognition of neonatal subgaleal haemorrhage through knowledge of risk factors and adequate communication within the health team treating the woman in labour. Especially vacuum-assisted extraction of the child significantly multiplies the incidents of subgaleal haemorrhage. The high mortality is directly associated with disseminated intravascular coagulation and bleeding. Early monitoring and treatment with replacement of blood volume is crucial. Education concerning this condition is therefore of great importance.
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Affiliation(s)
- Line Thorup
- Anæstesiologisk Afdeling, Regionshospitalet Randers, Skovlyvej 1, 8900 Randers, Denmark.
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Crane AK, Geller EJ, Bane H, Ju R, Myers E, Matthews CA. Evaluation of pelvic floor symptoms and sexual function in primiparous women who underwent operative vaginal delivery versus cesarean delivery for second-stage arrest. Female Pelvic Med Reconstr Surg 2013; 19:13-6. [PMID: 23321653 PMCID: PMC4532380 DOI: 10.1097/spv.0b013e31827bfd7b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to compare the prevalence and severity of pelvic floor symptoms and sexual function at 1 year postpartum in women who underwent either operative vaginal delivery (OVD) or cesarean delivery (CD) for second-stage arrest. METHODS In this cohort study, women with second-stage arrest in their first pregnancy who delivered between January 2009 and May 2011 at 2 different institutions were identified by an obstetric database using International Classification of Diseases, Ninth Revision, codes. Validated questionnaires evaluating pelvic floor symptoms and sexual function were administered. Subjects were dichotomized into those who underwent an OVD or a CD. Additional analyses by intent-to-treat and stratification of vacuum versus forceps operative deliveries were performed. RESULTS Of the 109 women who completed the 1-year postpartum symptom questionnaires, 53 (48.6%) had a successful OVD, 20 (18.3%) failed OVD and underwent CD, and 36 (33%) underwent CD only. There were no differences between those who had a successful OVD and those who underwent a CD in either pelvic floor function or sexual function, but bulge symptoms were more common in the OVD group (7.5% vs 0, P = 0.05). When analyzed by intent-to-treat (planned OVD vs planned CD), pelvic floor symptoms remained similar between groups. However, those in the planned CD group reported higher orgasm and overall sexual satisfaction scores. CONCLUSIONS In this sample of primiparous women with second-stage arrest, mode of delivery did not significantly impact pelvic floor function 1 year after delivery, except for bulge symptoms in the OVD group and sexual satisfaction in the planned CD group.
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Affiliation(s)
- Andrea K Crane
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
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Affiliation(s)
- Fangzhong Luo
- University of Virginia School of Nursing, Charlottesville, VA, USA.
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Schuller C, Känel N, Müller O, Kind AB, Tinner EM, Hösli I, Zimmermann R, Surbek D. Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery. Am J Obstet Gynecol 2012; 207:416.e1-6. [PMID: 22959831 DOI: 10.1016/j.ajog.2012.08.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to compare the stress response and pain expression of newborns (NBs) in the early postpartum period. STUDY DESIGN This was a prospective study with 280 NBs enclosed at 3 Swiss university hospitals. Stress response and pain reaction were analyzed according to the mode of delivery: elective cesarean section (ELCS), spontaneous vaginal delivery, and assisted vaginal delivery by vacuum extraction (VE). Saliva cortisol and clinical pain expression were evaluated after delivery and before and after heel prick for metabolic screening. RESULTS Significant differences were evident during the first 72 hours postpartum with highest nominations in the VE group. Meconium-stained amniotic fluid was the only intrapartum stress factor with an impact on clinical pain expression. CONCLUSION NBs delivered vaginally show a higher incidence of stress response and pain expression than infants of the ELCS group. The long-term impact of these findings remains to be determined.
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Affiliation(s)
- Christine Schuller
- Department of Obstetrics and Gynecology, University Hospital Bern, Switzerland
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Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med 2012; 48:387-392. [PMID: 22820826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Although childbirth is a well-known cause of coccydynia, this condition has not been studied previously. AIM To explore the characteristics of postpartum coccydynia and identify risk factors. DESIGN A case series study. SETTING A specialist coccydynia clinic in a department of physical medicine in a university hospital. METHODS A series of 57 women suffering from postpartum coccydynia was analyzed and compared with a control group of 192 women suffering from coccydynia due to other causes. Dynamic radiography enabled a comparison of the coccygeal mobility in the two groups. RESULTS 7.3% of the cases of coccydynia in female patients seen in our clinic were related to childbirth. The pain appeared as soon as the patient adopted the sitting position after delivery. The deliveries had often been performed with instruments (forceps deliveries: 50.8%; vacuum-assisted deliveries: 7.0%) or were spontaneous but described as "difficult" (12.3%). Luxation of the coccyx was observed in 43.9% of the cases and 17.0% of the controls. Fracture of the coccyx was involved in 5.3% of the cases. A body mass index >27 and ≥2 vaginal deliveries were associated with a higher prevalence of luxation of the coccyx. CONCLUSION Postpartum coccydynia is often associated with a difficult delivery, with the use of forceps in 50.8% of cases. Luxation and fracture of the coccyx are the two most characteristic lesions. CLINICAL REHABILITATION IMPACT Our results bring a better knowledge and should allow a better management of this specific etiology of coccydynia.
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Affiliation(s)
- J-Y Maigne
- Physical Medicine Department, Hôtel-Dieu Hospital, Paris, France.
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Gumanga SK, Kwame-Aryee R, Seffah JD, Amuzu SK. Ten -year review of vacuum assisted vaginal deliveries at a district hospital in Ghana. West Afr J Med 2012; 31:192-197. [PMID: 23310941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To find the incidence, indications, failure rate and the maternal and neonatal morbidity associated with the use of the vacuum extractor in a district hospital. METHODS A retrospective study of vacuum assisted vaginal deliveries. SETTING Holy Family Hospital, Nkawkaw from 1st January 2000 to 31st December 2009. RESULTS There were a total of 22,947 deliveries at the Holy Family Hospital over the ten year period of the study. There were 180 (0.78% of the total deliveries) cases of vacuum extraction out of which 164 (91.1%) of the extractions had successful vacuum assisted vaginal deliveries. The incidence of successful vacuum assisted vaginal delivery was 0.71% of the total number of deliveries. The failure rate of vacuum extraction was 8.9%. The commonest indications for vacuum assisted vaginal delivery were delayed second stage 40.5%, and poor maternal effort 29.3%. The maternal complication rate was 3.1% while 16 (9.7%) babies were admitted to babies unit with birth asphyxia and other complications which were mainly minor injuries. CONCLUSION The vacuum extractor is an effective and safe device for assisted vaginal delivery with high success rate even in a district hospital. Steps should be taken to encourage the safe use of vacuum assisted vaginal deliveries and it should be made more accessible.
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Affiliation(s)
- S K Gumanga
- Departments of Obstetrics & Gynaecology, University for Development Studies, Tamale, Obstetrics & Gynaecology, University of Ghana Medical School, Accra
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Santín-Amo JM, Gelabert-González M, Villa-Fernández JM, Castro-Bouzas D, Serramito-García R, García-Allut A. [Chronic subgaleal hematoma in a child. Case report]. Neurocirugia (Astur) 2011; 22:261-263. [PMID: 21743948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Neonatal subgaleal hematomas are under-diagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the live of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuum-assisted delivery that required surgical treatment.
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Affiliation(s)
- J M Santín-Amo
- Servicio de Neurocirugía Hospital Clínico Universitario de Santiago de Compostela. Departamento de Cirugía. Universidad de Santiago de Compostela
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