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At least 1,027 records · Page 57Linked to original sources
PubMed2001

Trends in operative vaginal delivery rates and associated maternal complication rates in an inner-city hospital.

OBJECTIVE: The aims of this study were to determine trends in operative vaginal delivery rates in a large inner-city hospital and to assess associated risks. STUDY DESIGN: We performed a retrospective cohort study (1980-1996) of women with singleton term pregnancies who underwent operative vaginal delivery at Grady Memorial Hospital, Atlanta. Maternal complication rates were compared between forceps-assisted and vacuum-assisted methods. RESULTS: There was a decline in forceps-assisted deliveries during the 1980s and an increase during the 1990s. The vacuum-assisted delivery rate was exceedingly low during the 1980s and increased during the 1990s. Women who underwent forceps-assisted delivery were more likely to be <24 years old, to be nulliparous, and to have had regional anesthesia, midline episiotomies, and infant presentations other than occipitoanterior (P <.001). Women who underwent forceps-assisted deliveries had increased risks of postpartum infection, cervical laceration, prolonged hospital stay, perineal laceration, and postpartum complications. CONCLUSION: There were upward trends in the rates of operative vaginal delivery at this inner-city hospital. Women who underwent forceps-assisted delivery had greater rates of maternal complications than did those who underwent vacuum-assisted delivery.

Adult↗
PubMed1982

Outcome of delivery subsequent to induced vacuum-aspiration abortion in parous women.

In a historical prospective study covering 1970-1978, the authors evaluated the outcome of delivery to 429 parous women subsequent to a legally induced first-trimester vacuum-aspiration abortion during 1970-1975 in Uppsala County, Sweden. This outcome was compared with the outcome of delivery to 391 randomly chosen matched parous women and that of all parous women in Sweden in 1975. Confounding variables were controlled for in multiple regression analysis using infant birth weight and gestational duration as dependent variables. In this analysis, no harmful effects of vacuum-aspiration abortion were found. Pre-term deliveries and low birth weight infants did not occur more frequently after such abortions. The study did not disclose any association between vacuum-aspiration abortion in parous women and an unfavorable outcome of subsequent delivery.

Abortion, Induced↗
PubMed2006

Chart documentation of informed consent for operative vaginal delivery: is it adequate?

OBJECTIVES: To determine the documentation frequency of informed consent for women undergoing a trial of nonemergent instrumental delivery. STUDY DESIGN: A retrospective chart review of instrumented vaginal deliveries from 1992 to 2005 was performed. Cases were identified from a Labor and Delivery database and hospital records were reviewed for documentation of associated risks, general consent for the procedure, indication, and option of cesarean delivery (CD). RESULTS: Three hundred forty six charts were reviewed: 246 were excluded for an emergency delivery (19%), misclassification (25%), or lost notes (27%). In the remaining 100 cases, 61% had a general consent for instrumented vaginal delivery. Documentation of any maternal or neonatal risks was found in 3% and 0%, respectively. The option of a cesarean delivery was documented in 22% of the cases. When comparing 5-year time intervals before and after 2000, there was no increased frequency in documentation of maternal or neonatal risks. CONCLUSIONS: Documentation of informed consent for instrumented vaginal delivery is inconsistent and should be improved.

Consent Forms↗
PubMed1993

The Hay's flexion rotation obstetric forceps: reestablishing relevance in modern obstetrics.

A prospective evaluation of 140 forceps deliveries with the Hay's flexion rotation obstetric forceps was undertaken over a 5-year period. The Hay's forceps was used for a variety of indications and included outlet forceps application in 35.7%, low or midforceps application in 29.3% with forceps rotation in 16.4%, 19.3% of applications for an aftercoming head and 19.3% applications at caesarean section. Outlet forceps deliveries had maternal and neonatal outcomes comparable with the Wrigley's short obstetric forceps. Midforceps applications were compared to the Simpson's long forceps, with maternal morbidity at 21% being significantly less, blade marks being the only neonatal morbidity and the Apgar scores being significantly higher with the Hay's forceps. Every forceps application at caesarean section resulted in an easy delivery. Thus the Hay's forceps with innovations such as parallelism and flexion potential could revalidate the role of the forceps in contemporary obstetrics.

Cesarean Section↗
PubMed1992

A randomized prospective study comparing delivery with metal and silicone rubber vacuum extractor cups.

OBJECTIVE: To determine the relative benefits and complications of assisted vaginal delivery with metal and silicone rubber vacuum extractor cups. DESIGN: Prospective randomized controlled study. SETTING: A busy referral maternity hospital in Kathmandu, Nepal. SUBJECTS: 101 women were assigned to delivery with the Silc-cup and 98 to delivery with the metal cup. MAIN OUTCOME MEASURES: Success rate at achieving delivery with the assigned instrument and incidence of neonatal trauma. Analysis was by 'intention to deliver' with women remaining in their original group regardless of the eventual mode of delivery. RESULTS: Randomization resulted in two groups of women similar in respect of age, parity, gestation and indication for delivery. The overall success rate was similar for the two instruments (Silc-cup 85% and metal cup 87%). The Silc-cup was more likely to fail if there was excessive caput (seven failures compared with one in the metal cup group). The frequency of clinically significant maternal trauma was low in both groups. There were fewer babies with clinically significant scalp trauma in the Silc-cup group (22%), compared with the metal cup group (37%). CONCLUSIONS: The data indicate a greater tendency for the Silc-cup to fail when excessive caput is present but that metal cups are associated with increased scalp injuries.

Adult↗
PubMed1999

Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse.

OBJECTIVE: To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study. DESIGN: Follow up of a randomised controlled trial. SETTING: District general hospital in the West Midlands. POPULATION: Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n = 115) and vacuum extractor (n = 113). MAIN OUTCOME MEASURES: Bowel and urinary dysfunction, child vision assessment, and child development. RESULTS: Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97, 95% CI 0.38-2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups. CONCLUSIONS: There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.

Adult↗
PubMed2006

A prospective randomised controlled trial of the Kiwi Omnicup versus conventional ventouse cups for vacuum-assisted vaginal delivery.

OBJECTIVE: To evaluate the performance and safety of the Kiwi Omnicup and compare it to conventional vacuum cups in routine clinical practice. DESIGN: A randomised controlled trial of the Kiwi Omnicup versus conventional vacuum cups. SETTING: Queen Charlotte's and Chelsea Hospital, a tertiary referral hospital in London from April 2001 to March 2004. POPULATION: Women requiring assisted vaginal delivery by ventouse. METHODS: Women were randomised to the Kiwi Omnicup (n=206) or conventional vacuum cups (n=198). Data regarding maternal demographics, labour, mode of delivery and maternal and neonatal outcome were collected. MAIN OUTCOME MEASURES: Failure of delivery with instrument of first choice. RESULTS: The Kiwi Omnicup was less successful at delivery with instrument of first choice than the conventional ventouse, failure rate 30.1 versus 19.2% (RR 1.58; 95% CI 1.10-2.24). It was associated with a greater number of cup detachments (mean 0.68 compared with 0.28, with 44% compared with 18% having at least one detachment [P<0.0001]). There was no difference in the incidence of severe maternal trauma, and there were no cases of serious neonatal injury. CONCLUSIONS: The Kiwi Omnicup is less successful than conventional ventouse in achieving vaginal delivery, but its safety profile is comparable.

Adult↗
PubMed1979

Kielland's forceps: association with neonatal morbidity and mortality.

The incidence of certain neonatal complications associated with the use of Kielland's forceps was analyzed retrospectively in liveborn singleton babies delivered at this hospital between January and December 1976. The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications. Babies on whom Kielland's forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit. Neither maternal height nor the infant's birth weight or occipitofrontal head circumference influenced the occurrence of neonatal complications. The results also suggest that neither the speed of cervical dilatation nor the timing of engagement of the fetal head is of help in predicting the occurrence of neonatal complications after the use of Kielland's forceps.

Anesthesia, Obstetrical↗
PubMed2004

Outcomes after vacuum-assisted deliveries. Births attended by community family practitioners.

OBJECTIVE: To assess success rates, modes of delivery following failure, complications of mothers and newborns, and effect of extractor station and parity on vacuum-assisted deliveries attended by family physicians. DESIGN: Retrospective audit. SETTING: Community hospital. PARTICIPANTS: Thirty-five family physicians providing maternity care. MAIN OUTCOME MEASURES: Complications, parity, and extractor station of 153 vacuum-assisted deliveries from April 1, 2000, to March 31, 2003. RESULTS: Family physicians attempted 153 vacuum deliveries (82 at low station, 71 at outlet station) and had a 94.1% success rate. Of nine failed vacuum deliveries (eight at low station and one at outlet station), four were subsequently delivered by forceps and five by cesarean section. Except for one case of subdural hematoma, complications were few. Nulliparity was associated with six of the nine failed vacuum deliveries. CONCLUSION: Family physicians were usually successful with vacuum-assisted deliveries. Complications were infrequent and rapidly resolved, but one failure, which was followed by a failed forceps delivery and eventual cesarean section, resulted in a serious complication. Low station and nulliparity were associated with failure of vacuum-assisted deliveries.

Adult↗
PubMed2005

Perineal care.

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Delivery, Obstetric↗
PubMed2006

Perineal care.

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Anesthesia, Epidural↗