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At least 631 records · Page 35Linked to original sources
PubMed1984

Plasma haptoglobin levels in vacuum extracted neonates.

In order to examine the pathogenesis of neonatal hyperbilirubinemia associated with vacuum extraction, we have compared plasma haptoglobin and bilirubin levels and blood hematocrits of vacuum extracted neonates with those of newborns who underwent a normal vaginal delivery. Plasma haptoglobin and blood hematocrits of the 12 vacuum patients measured on the third day of life were significantly lower (21.7 +/- 5.3 vs. 46.5 +/- 7.5 mg%; p value less than 0.01 and 52.3 +/- 1.3 vs. 59.7 +/- 1.8%; p value less than 0.005, respectively) than the 12 control patients (values are mean +/- SEM). This trend was apparent whether or not cephalhematoma was present after vacuum extraction: However, the mean bilirubin level was significantly higher than the controls only when cephalhematoma was present. Those results suggest that the higher incidence of neonatal hyperbilirubinemia previously observed after vacuum extraction, is the result of an increased hemolysis of blood sequestered in scalp lesions. Since evidence for enhanced RBC destruction has been demonstrated whether or not cephalhematoma was present, the possibility of hyperbilirubinemia should be anticipated in any case of vacuum delivery.

Bilirubin↗
PubMed1980

Subgaleal hematoma. A complication of instrumental delivery.

Subgaleal hematomas (SGH) are rare but potentially fatal accumulations of blood beneath the galea aponeurotica of the scalp in the newborn. One hundred twenty-three SGH cases are summarized from the literature. Sixty-four percent occurred after instrumental delivery. The lesion is most often associated with mid-forceps operations (14 cases) and vacuum extraction (60 cases), but SGH also has been recorded after spontaneous vaginal delivery (35 cases) and after cesarean section (11 cases). Intrapartal hypoxia of the fetus and neonatal coagulopathies are prominent features of both spontaneous and instrumental delivery cases. Other risk factors include prematurity, macrosomia, prolonged labor, cephalopelvic disproportion, primiparity, male sex, and African lineage. Mortality for SGH is 22.8%. Early recognition, differentiation from benign cephalohematoma, and prompt treatment by adequate blood replacement and correction of coagulopathies are the major determinants of successful management.

Birth Injuries↗
PubMed1992

Trends in obstetric operative procedures, 1980 to 1987.

OBJECTIVES: Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. METHODS: We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. RESULTS: The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. CONCLUSIONS: As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures.

Adolescent↗
PubMed1976

Uterine rupture and vacuum extraction.

Eleven uterine ruptures occurred among 11415 vacuum extractions, and these cases are analysed. Cervical tears extending into the lower uterine segment or into the broad ligament occurred in 4 cases, lower segment tears in 6 and a fundal tear in 1. One patient died of respiratory failure. The possible cause of uterine rupture with vacuum extraction appear to be a combination of an unengaged fetal head, an incompletely dilated cervix and an undetected mild cephalopelvic disproportion especially in grandmultiparae, dehiscent or weak uterine scars, prolonged traction without progress, manipulations in shoulder dystocia and obstruction and excessive non controlled traction. Uterine rupture can be minimized by careful selection of cases, proper technique and early recognition of failure.

Extraction, Obstetrical↗
PubMed1993

Anal sphincter trauma during instrumental delivery.

OBJECTIVES: To determine the incidence of defecatory symptoms, pudendal nerve damage and mechanical trauma to the anal sphincters during vacuum and forceps delivery. METHODS: Anal endosonography, manometry, pudendal nerve terminal motor latency (PNTML) measurements and perineometry were performed in 43 primiparae who had an instrumental delivery (17 vacuum and 26 forceps) and in 47 who had a normal vaginal delivery (controls). RESULTS: Defecatory symptoms developed in 10 (38%) women following a forceps delivery compared with 2 (4%) in the control group (P = 0.0003), and 2 (12%) following a vacuum extraction (P = NS). Anal sphincter defects occurred in 21 (81%) forceps deliveries compared with 17 (36%) controls (P = 0.0005) and 4 (21%) vacuum extractions (P = NS). Anal pressures were lower in those who developed a sphincter defect (P < 0.00001). PNTML was not significantly altered by the mode of delivery. CONCLUSIONS: Compared with vacuum extraction, forceps delivery is associated with significantly more damage to the anal sphincters and hence an increased incidence of defecatory symptoms.

Adult↗
PubMed1984

Cranial ultrasound after forceful midpelvis vacuum extraction at term.

The heads of 28 non-hypoxic, full-term infants of normal gravidas delivered by forceful vacuum extraction were examined with ultrasound during the early neonatal period. All echographic findings were normal and all neonates had an uneventful evolution during the first week of life. Addendum: Since this article was completed, a massive intracranial haemorrhage occurred in a non-hypoxic full-term newborn after elective midpelvic vacuum extraction. The intervention was performed by a resident who, despite the guidelines did not call the senior obstetrician after three unsuccessful attempts to extract the fetus. The head was stationed, 2 cm above the level of the ischial spines, not completely flexed with the occiput in the right-anterior position. The newborn died at the age of 3 hours. Autopsy showed a tear of the tentorium cerebelli and the vena cerebri magna.

Brain Injuries↗