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Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery.

A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear to predispose to an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed to address this still open question more rigorously.

Adult↗

Urinary incontinence in pregnancy and the puerperium.

OBJECTIVE: To describe the incidence of urinary incontinence (UI) during pregnancy and the puerperium and to identify potential contributing factors. DESIGN: A descriptive correlational design, using participant interviews and reviews of the existing medical records to determine the incidence of UI in pregnancy and the puerperium and to examine relationships between and among several variables. The variables included parity, episiotomy, use of forceps/vacuum extractor, type of anesthesia, prolonged Stage II labor, and race. Data were collected via two personal interviews and review of medical records. The first interview was conducted during the recruitment of each participant; the second was a telephone interview conducted 4 to 6 weeks postpartum. Data collected from the medical records included obstetric history, weeks of gestation, and estimated date of delivery. Data were entered into data files for analysis with SPSS 8.0 and summarized with descriptive statistics. SETTING: A secluded area of a university teaching hospital prenatal clinic. PARTICIPANTS: A convenience sample of 50 pregnant women, at least 18 years old, who received their care at a large university hospital prenatal clinic in the southeastern part of the United States. RESULTS: First Interview (N = 50). More than half (62%; n = 31) of the sample reported some degree of involuntary urine loss during their pregnancy. The racial distribution of those reporting UI was the following: white (70%; 21 out of 30); African American (44%; 8 out of 18); Hispanic/Asian (100%; n = 2). Among the participants who experienced UI (n = 31), 76% (n = 23) reported that their health care provider never asked if they were experiencing any UI symptoms. Second Interview (n = 24). Only 48% of the initial participants could be contacted for the second interview because of changes in residence or telephones being disconnected with no forwarding number. Of the women in this sample who reported UI during the first interview (59%; n = 14), 7 (50%) continued to experience UI 4 to 6 weeks postpartum. The 2 remaining participants who reported UI 4 to 6 weeks postpartum (22%) had not experienced UI during pregnancy. Of the participants experiencing postpartum UI, 77% (n = 7) were white. Almost half of the participants with postpartum UI were ages 35 or older (44%; n = 4). Among the participants reporting episiotomy (n = 4), 3 (75%) reported having UI 4 to 6 weeks postpartum. CONCLUSIONS: Study results support the conclusion that childbirth, specifically vaginal birth, is a major factor in developing UI in the early postpartum period. Age, race, and use of episiotomy appear to be contributing risk factors.

Adult↗

[Is a vaginal breech delivery still justified? (author's transl)].

In our series of vaginal breech deliveries the morbidity from hypoxia and acidosis showed no difference to the same type of morbidity in our series of breech deliveries by Caesarean section. The correct selection of cases, intensive monitoring during labour and the management of the second stage of labour as outlined in our paper are the most important perequisites which permit to plan and justify a vaginal breech delivery in present obstetric practice.

Acidosis↗

Operative vaginal delivery. ACOG Technical Bulletin. Number 152--February 1991.

With any operative vaginal delivery, it is important to document in the medical record the indications for the procedure, including the position and station of the vertex and specifics of technique, timing, and ease of the procedure. The use of cord pH and blood gas determinations may be helpful for further evaluation of the fetus.

Extraction, Obstetrical↗