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At least 739 records · Page 41Linked to original sources
PubMed1998

Occult anal sphincter trauma following randomized forceps and vacuum delivery.

OBJECTIVE: To determine the prevalence of occult anal sphincter trauma 5 years after randomization to forceps and vacuum delivery. METHOD: Anal endosonography and manometry was performed in 44 of 313 women who had originally participated in one center of the Keele University Multicenter Assisted Delivery Trial at the North Staffordshire Maternity Hospital between September 1989 and May 1990. RESULTS: 50% admitted to defecatory symptoms and anal sphincter defects were identified in 61%. On the basis of intention to treat, 82% of forceps (n = 17) and 48% of vacuum deliveries (n = 27) had occult sphincter defects (P = 0.03). In four women, both instruments were used. However, the preponderance of defects in the forceps group persisted even when analysis was performed according to the final mode of delivery as well as in the group where only one instrument was used (n = 40). There was a significant fall in maximum squeeze anal pressure in the forceps group compared to the vacuum group (56 vs. 36 mmHg; P = 0.0007). Although twice as many in the forceps group suffered anal incontinence (32% vs. 16%) significance was not reached. CONCLUSIONS: Vacuum delivery appears to be associated with less occult anal sphincter trauma than forceps delivery. A large prospective randomized study is required to address the impact of specific situations, such as failed instrumentation with use of a second instrument and rotational delivery.

Adult↗
PubMed2001

Comparison of maternal and infant outcomes between vacuum extraction and forceps deliveries.

The authors conducted a population-based historical cohort study in the Canadian province of Quebec to assess the maternal and infant outcomes associated with vacuum extraction and forceps deliveries. The study database contains information on 305,391 mother-infant dyads (linked by a common institutional code and hospital chart number) for singleton live vaginal births with a nonbreech presentation at the gestational age of 37 or more completed weeks and a birth weight between 2,500 and 4,000 g during fiscal years 1991/1992 to 1995/1996. Of the births, 31,015 were delivered by vacuum extraction, and 18,727 were delivered by forceps. Compared with delivery by forceps, the adjusted risk ratios for third-/fourth-degree perineal laceration, intracranial hemorrhage, subdural or cerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, cephalhematoma, and neonatal in-hospital death were 0.48 (95% confidence interval: 0.45, 0.50), 1.28 (95% confidence interval: 0.73, 2.25), 0.97 (95% confidence interval: 0.49, 1.93), 0.99 (95% confidence interval: 0.16, 5.97), 5.44 (confidence interval: 1.26, 23.43), 2.02 (95% confidence interval: 1.89, 2.16), and 0.93 (95% confidence interval: 0.32, 2.70), respectively. The authors conclude that vacuum extraction causes less maternal trauma but may increase the risk of cephalhematoma and certain types of intracranial hemorrhage (e.g., subarachnoid hemorrhage).

Adult↗
PubMed1982

Vacuum extraction and neonatal jaundice.

Various fetal scalp lesions are related to the use of the vacuum extractor. Blood sequestered in these lesions could result in an increased bilirubin load on the functionally limited neonatal liver, leading to the development of hyperbilirubinemia. In the present study bilirubin levels of vacuum extracted neonates were compared with those of non-instrumentally delivered babies during the first 72 hours of life. Sixty-nine vacuum extracted neonates had higher bilirubin levels than 56 non-instrumentally delivered babies at 24 (114 mumol/l vs. 96 mumol/l), 48 (163 vs. 141) and 72 (194 vs. 144) hours of age. The p values were 0.05, less than 0.025 and less than 0.001 respectively. This trend was apparent in both oxytocin induced and non-induced deliveries and whether or not phototherapy cases were included in the analysis. The incidence of hyperbilirubinemia requiring phototherapy was higher after vacuum extraction than after non instrumental delivery (27.5% vs. 12.5%; p less than 0.04). Analysis of our results unexpectedly indicated that oxytocin induction was generally associated with an attenuation of bilirubin levels after both vacuum extraction and spontaneous delivery. The clinician attending newborn babies should be aware of the higher incidence of neonatal hyperbilirubinemia associated with vacuum extraction.

Bilirubin↗
PubMed1984

[Indications and technic of operative vaginal delivery in vertex presentation].

In operative vaginal delivery in vertex presentation we pay attention to a separation in the indication for using a forceps or using a vacuumextractor. A delivery with a vacuumextractor is recommendable only in a flexion of the fetal head, in a low obstetrical resistance and with slow tractions. A delivery with a forceps is recommendable even in a deflexion of the fetal head, in a high obstetrical resistance and in fetal distress situations. A comparison in 2 collectives, each of a time period of 5 years, shows an interesting difference. In collective 1 (1963 to 1967) the frequency of forceps deliveries was 2.2% and of vacuumdeliveries was 3.2%. In collective 2 (1978 to 1982) the frequency of forcepsdeliveries was 4.1% and of vacuumdeliveries was 0.4%. Caused by a separation of the indication and by a consequent fetal monitoring there was an improvement in fetal and maternal morbidity and mortality. Using a handle in forceps delivery the procedure is more easy and less harmful for the baby.

Extraction, Obstetrical↗
PubMed1980

Retinal haemorrhages in the newborn.

The present study shows the frequency and severity of retinal haemorrhages in 200 newborn, of which 100 were delivered spontaneously, 51 delivered by vacuum extractor and 49 by forceps. The incidence of retinal haemorrhages was highest in the vacuum group (50%), lowest in the forceps group (16%), while the spontaneously delivered children showed an incidence of 41%. The incidence of severe retinal haemorrhages was about five times higher in the vacuum group than in both forceps and control groups. The authors propose a quantitative grading of the haemorrhages. The purpose has been to obtain a better way of relating the haemorrhages to mode of delivery and probably also to relate retinal haemorrhages to possible brain damage.

Breech Presentation↗
PubMed1987

Neonatal retinal hemorrhages and neurobehavior related to tractive force in vacuum extraction.

Fifty clinically indicated vacuum extractions were studied to evaluate a possible relationship between neurobehavioral abnormality, retinal hemorrhages and the tractive force used for delivery. A Vacuum Extractor Recorder (Type SF 30, Knick), was used to measure the forces necessary for delivery of the head. Infants delivered by the use of extensive tractive force showed no greater incidence of neuropathology than those delivered with less tractive force. The retinal hemorrhages were equally distributed among the infants, irrespective of the tractive force applied or the neurobehavioral assessment. The implication is that retinal hemorrhages cannot be used to evaluate the extent of cerebral influence after birth and that the main cause of neurobehavioral abnormality is the condition leading to the use of the vacuum extractor (VE).

Adult↗
PubMed1989

[The assessment of the safety of vacuum extraction deliveries under routine epidural block].

To assess the safety of vacuum extraction (V.E.) deliveries under continuous lumbar epidural block (E.B.) with Bupivacain, the modified Krebs score in CTG, Apgar score, cord arterial blood acid-base balance, hypoxanthine, CPK, CPK-BB, Neuron specific enolase and c-AMP were examined. A total of 74 full term oxytocin-induced labors were divided into three groups: A) 21 cases by V.E. under E.B., B) 34 cases under E.B. only, and C) 19 cases without V.E. or E.B. There was no difference in age, gestational weeks in the three groups. However, the incidence of primiparas was highest in group A. Though CTG showed a temporary low Krebs score in group A within 30 minutes after the initiation of E.B., it was found that there was no significant difference between the three groups 30 minutes before parturition. The apgar score, cord arterial blood pH, PO2 and B.E. were also found to be similar in all three groups. Among various kinds of substances in the cord blood, both CPK-BB and c-AMP showed a striking rise in group A, compared to groups B and C. Therefore, the use of V.E. under E.B. might be hazardous to the well-being of the newborn infant.

Accident Prevention↗
PubMed1999

Use of obstetric forceps in Finland today--experience at Vaasa Central Hospital 1984-1998.

BACKGROUND: Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital. METHODS: A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section. RESULTS: There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome. CONCLUSIONS: Forceps delivery appears to be a safe alternative in our setting.

Adult↗
PubMed1975

Very early termination of pregnancy (menstrual extraction).

Very early termination of pregnancy was performed on 424 women in three London teaching hospitals. Altogether 90% of the women were no more than 14 days overdue, and 67% of these had histological evidence of pregnancy. The procedure differed little in technique or its acceptability to the patient from termination done later in the first trimester. The similar incidence of complications suggested that it is not an alternative to conventional contraception. The response of patients, general practitioners, and referral agencies, however, indicated that there is a definite need in the community for a very early termination service.

Abortion, Induced↗
PubMed1975

The hazards of vacuum aspiration in late first trimester abortions.

The incidence of somatic complications in connection with legal termination of pregnancy by vacuum aspiration was analysed in 1,123 hospital patients. Special attention was paid to complication rates in relation to gestational age. It was found that the incidence of major uterine haemorrhage increased with gestational period, being unexpectedly high in the 12th week. When anaesthesia was supplemented with halothane there was a significantly higher incidence of uterine haemorrhage that when this anaesthetic was avoided. The results indicate that strict principles for the operation procedure are mandatory to reduce blood loss and other complications. It is suggested that the end of the 12th week should not be considered as a "magic" time limit for vaccum aspiration but that the policy should aim at early intervention, preferably before the end of the 10th week. In the event of late first trimester abortions or "border line" cases it is of advantage to administer prostaglandin extra-amniotically for pre-operative dilatation of the cervix.

Abortion, Induced↗