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At least 775 records · Page 43Linked to original sources
PubMed1979

Fetal cranial injuries related to delivery with the Malmström vacuum extractor.

The literature regarding the propensity of the vacuum extractor to cause fetal cranial injuries is reviewed. Eighteen subaponeurotic hemorrhages occurred in 14,276 vacuum extractions (VE). Scalp abrasion or laceration occurred in 12.6%, cephalohematoma in 6%, and intracranial hemorrhage in 0.35%. Assessments of early and late manifestations of neurologic damage indicate little difference between VE deliveries and spontaneous deliveries. An uncorrected perinatal mortality rate of 25.8 per thousand is tabulated, which reduced to 15 per thousand when corrected for deaths not related to the mode of delivery. Scalp anatomy and the forces exerted on it with vacuum extraction are examined, and suggestions to minimize scalp injuries are offered.

Craniocerebral Trauma↗
PubMed1993

[Abdominal pregnancy, a rare anatomoclinical entity. 4 case reports (1981-1990)].

The opportunity is taken, on the basis of 4 cases of abdominal pregnancy and a review of the literature, to attempt to analyse the various aspects of this increasingly rare pathology. Its incidence is low, being evaluated by our own study at 4/85 757 deliveries, i.e.: 1/21 439 deliveries collected at the Maternity and Neonatology centre of Rabta Tunis during a 10-year period (1981-1990). The essential epidemiological factor is the low socio-economic and cultural status seen in the patients studied. Clinical signs were predominated by metrorrhagia, abdominal pain, disturbed intestinal function and fetal death in utero. The delay in diagnosis explains the onset of frequent fetal complications in the form of fetal death in utero (3 cases out of 4) and of various fetal malformations. Ultrasonography is the essential investigation enabling diagnosis in the presence of clinical suspicion. Surgery is obligatory, excluding any attempt in the majority of cases at extraction of the placenta, which is left in place.

Adult↗
PubMed1981

Dilation and evacuation: a preferred method of midtrimester abortion.

A comparison between two methods of therapeutic termination of midtrimester pregnancies was performed. Twenty-nine patients at 13 to 16 weeks' gestation underwent dilation and evacuation (D and E). A second group, of 29 patients at 16 to 19 weeks' gestation underwent therapeutic abortion by prostaglandin F2 alpha instillation. There was a significantly lower complication rate (6.9% versus 55%) and a shorter hospital stay of 1 full day in the D and E group. Also, the blood loss was not significantly greater in the D and E group.

Abortion, Therapeutic↗
PubMed1987

[Informing the patient about alternative surgical methods of delivery].

The article discusses a judgment passed by the Düsseldorf Supreme Court on 30 January 1986. An obstetrician had resorted to vacuum extraction during multiple birth (twins) because one twin was in imminent danger of hypoxia. It was found only later that during this procedure he had caused a fracture of the parietal bone with subsequent subdural hematoma. This damage inflicted on the infant had initially remained unnoticed and resulted in hemiplegia of the left side. The infant, legally represented by his parents, filed a suit for compensation against the Board of Governors of the hospital. The Düsseldorf Supreme Court ruled on 30 January 1986 that the respondent was liable to compensation. The Court was convinced that the consent obtained from the infant's mother to proceed with vacuum extraction had been invalid at that time because the physician had failed to draw her attention beforehand to the available alternative surgical method of delivery, namely, to Caesarean section. Hence, the Court argued, the procedure followed during birth was against the law so that the Board of Governors was directly liable independent of whether the responsible obstetrician had or had not been guilty of malpractice. In addition, the liability of the Board of Governors follows from the fact that the infant had not been examined by a paediatrician immediately after birth as would have been mandatory had delivery been conducted lege artis.(ABSTRACT TRUNCATED AT 250 WORDS)

Extraction, Obstetrical↗
PubMed1975

Identification of high risk labours by labour nomogram.

The labour stencil representing the expected cervimetric progress of normal labour was used in 741 consecutive spontaneous labours to identify high-risk labours which needed oxytocic stimulation. Uterine contractions were stimulated if progress extended two hours past the nomogram, which resulted in shorter labours, fewer instrumental deliveries and caesarean sections, and babies with higher Apgar scores than in those dysfunctional labours which were not stimulated. According to the protocol used 36% of primigravid and 13% of multigravid labours needed acceleration. The remaining patients did not need any oxytocic interference during the first stage. This selection of patients is important to prevent a major obstetric advance being abused and discredited at a time when the profession and public are questioning the safety of active labour.

Anesthesia, Epidural↗
PubMed1990

Tentorial hemorrhage associated with vacuum extraction.

The clinical and radiologic descriptions of three neonates with tentorial hemorrhage after vacuum extraction are reported. All patients were full term, with Apgar scores of 8 or more; one patient experienced fetal distress during delivery. Within 36 hours after birth, the neonates had multiple generalized seizures; computed tomography or magnetic resonance imaging outlined distinctive tentorial hemorrhages with extension over the superior surface of the cerebellum or inferior surface of the occipital lobe. One patient had diffuse hypoxic-ischemic injury, and another had bilateral temporal lobe infarcts. Treatment included medical control of seizures and intracranial hypertension; one patient had surgical evacuation of bilateral subdural hematomas. Follow-up from 1 to 5 years showed significant developmental delays in two patients. These cases demonstrate that the forces generated on the fetal cranium by vacuum extraction are similar to those produced by forceps and result in tentorial laceration, venous rupture, and subdural hemorrhage. Because these hemorrhages may be associated with significant ischemic injury, serial radiologic evaluation is recommended for the detection of persistent structural abnormalities.

Birth Injuries↗
PubMed1982

The beneficial effect of vacuum extraction of the fetus.

The vacuum extractor (VE) was applied electively after approximately 25 min of expulsion in 25 normal primiparae. Twenty-five identical parturients with spontaneous deliveries served as controls. The fetal scalp pH was measured at the beginning of the 2nd stage, and again in the cord blood of all newborns. Cardiac monitoring by scalp electrode was done for all fetuses throughout labor. The mean pH of the first blood sample was almost identical in the two groups, while the mean decrease in pH in the VE group was 0.077, against a mean change of 0.106 in the controls (p less than 0.05). In the FHR graph the total area of deceleration, and separately in the controls (p less than 0.05). In the FHR graph the total area of deceleration, and separately the up to 30 beats/min (area A) and of more than 30 beats/min (area B) were calculated. The mean total area of deceleration in the VE group was 14.76 cm2vis-à-vis 17.56 cm2 in the controls. Areas A and B were also smaller in the study group, but these differences were not statistically significant. The mean total deceleration time in the VE fetuses was 22.8 min, and 37.75 min in the controls (p less than 0.001). It is concluded that the application of the VE during the second stage lessens fetal depression, when compared with spontaneous delivery.

Extraction, Obstetrical↗
PubMed1984

Use of the soft, silicone obstetric vacuum cup for delivery of the fetal head at cesarean section.

Delivery of the fetal head at cesarean section can sometimes be very difficult, and serious maternal and fetal complications may occur. Recently a new soft, silicone obstetric vacuum cup was introduced for use on the fetal head at vaginal delivery. In 35 cases the cup was used for delivery of the fetal head at cesarean section. It is an effective, harmless alternative to conventional devices, especially in aiding the delivery of the high-floating head occurring spontaneously or occurring after the head impacted deep in the pelvis is dislodged.

Cesarean Section↗
PubMed1975

[Medical interruption of pregnancy in India (author's transl)].

The law on medical interruption of pregnancy was introduced in India in 1971. According to this, a pregnancy may be interrupted (only by a specialist) if the life or mental health of the mother is threatened or if there is a danger of severe bodily or mental abnormality in the child. The methods of interruption used are: 1. simple suction, 2. dilatation and curettage (one or two sessions), 3. vacuum aspiration, 4. hysterotomy (abdominal, vaginal), 5. intrauterine injections (hypertonic saline or glucose solution, urea, prostaglandins), 6. intrauterine bougie. After the operation the doctor must advice the patient on methods of contraception.

Abortion, Legal↗