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Results for “Extraction, Obstetrical”

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PubMed2006

Short-term maternal and neonatal outcomes by mode of delivery. A case-controlled study.

OBJECTIVE: Side-by-side comparisons of short-term maternal and neonatal outcomes for spontaneous vaginal delivery, instrumental vaginal delivery, planned caesarean section and caesarean section during labor in patients matched for clinical condition, age, and week of gestation are lacking. This case-controlled study was undertaken to evaluate short-term maternal and neonatal complications in a healthy population at term by mode of delivery. STUDY DESIGN: Four groups of healthy women, with antenatally normal singleton pregnancies at term, who underwent instrumental vaginal delivery (no. 201), spontaneous delivery (no. 402), planned caesarean section without labor (no. 402) and caesarean section in labor (no. 402) have been retrospectively selected. Outcome measures were maternal and neonatal short-term complications. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Maternal complications were mostly associated with forceps-assisted and vacuum-assisted instrumental deliveries (OR: 6.9; 95% CI: 2.9-16.4 and OR 3.0; 95% CI 1.1-8.8, respectively, versus spontaneous deliveries). No significant differences in overall complications were observed between spontaneous vaginal deliveries and caesarean sections, whether planned or in labor. By comparison with caesarean sections in labor, instrumental deliveries significantly increased the risk of complications (OR: 3.2; 95% CI: 1.6-6.5). Neonatal complications were also mostly correlated with forceps-assisted and vacuum-assisted instrumental deliveries (OR: 3.5; 95% CI: 1.9-6.7 and OR 3.8; 95% CI 2.0-7.4, respectively, versus spontaneous deliveries). By comparison with caesarean sections in labor, instrumental vaginal deliveries significantly increased the risk of complications (OR: 4.2; 95% CI: 2.4-7.4). CONCLUSIONS: In healthy women with antenatally normal singleton pregnancies at term, instrumental deliveries are associated with the highest rate of short-term maternal and neonatal complications.

Adult↗
PubMedDate not supplied

[Cesarean section for failed vacuum extraction: risk factors and maternal and neonatal outcomes].

OBJECTIVE: To evaluate risk factors associated with failed attempts of vacuum extraction and their outcomes. PATIENTS AND METHODS: All trial vacuum extractions (metal Minicup) from 1992 to 2000 in Besançon University Hospital Center were retrospectively analysed, namely 2447 cases. Univariate and multivariate analyses of failed vacuum extraction risk factors and descriptive analyse of outcomes were performed. RESULTS: The rate of failed vacuum extractions was 3.47% (85/2447). A multivariate analysis showed the following independent risks factors in failed extraction: extraction above pelvic level + 2 (OR = 1.8; CI 95%: 1.1-3), newborn weight (OR = 2.9; CI 95%: 1.8-4.9), parity >2 (OR = 0.08; CI 95%: 0.01-0.6). In case of failed vacuum extraction, newborns had a significantly higher rate of Apgar score <7 at 1 min (P = 0.0002), but not at 5 min. These newborns were most regularly admitted in pediatric care units (P = 0.01). CONCLUSION: The failed trial attempt vacuum extraction rate stays low. These failed instrumental extractions are more common in an extraction above pelvic + 2, a high fetal weight and an arrest during the second stage of labor. There is an increased adverse neonatal outcome. Clinical fetal weight estimation and diagnosis of presentation level in mother pelvis must be performed before vacuum extraction.

Adolescent↗
PubMed2005

[Side effects of induced abortion: results from a population-based survey].

OBJECTIVES: This study compares the gynaecological symptoms of women who have undergone an induced abortion to those who have not. We also compare the gynaecological side effects, in particular the infectious symptoms, following an induced abortion, according to the abortion technique, medical and surgical, in the year after the abortion. PATIENTS AND METHODS: A representative sample of 2863 women, aged 18 to 44, was interviewed by telephone between September 2000 and January 2001. Of these women, 401 declared an abortion in the last 5 years. Analysis of the gynaecological side effects according to the abortion technique was performed among the 199 women who terminated their pregnancy before the 8th week of amenorrhoea. RESULTS: Women with a history of induced abortion had a higher sexual risk profile than those with no such history. They also more frequently reported genital infectious symptoms. The comparison between medical and surgical abortions shows that women who had a medical abortion were more likely to report heavy and prolonged bleeding. On the contrary, we found no difference of infectious symptoms between the two techniques. DISCUSSION AND CONCLUSION: Our study does not support the idea of a reduction of infectious complications related to medical as opposed to surgical abortions. However, given the rapid diffusion of medical abortion, it seems important to carry on the investigations on the side effects related to medical abortions, in order to prevent them if necessary.

Abortifacient Agents↗
PubMed2004

Obstructed labor: using better technologies to reduce mortality.

OBJECTIVE: To identify, from the best available evidence, underutilized and promising technologies that may reduce maternal mortality from obstructed labor. METHODS: The author sought systematic reviews of randomized trials, individual randomized trials, and, in the absence of randomized data, non-randomized studies and clinical consensus. Data were presented according to the level of the evidence. RESULTS: Obstructed labor causes approximately 8% of maternal deaths, and indirectly contributes to a greater percentage. Proven or widely accepted technologies that help reduce mortality from obstructed labor include contraception, external cephalic version, the partogram, augmentation of labor, selective amniotomy, selective episiotomy, vacuum extraction, caesarean section, symphysiotomy, and destructive procedures for non-viable fetuses. Technologies of uncertain usefulness include maternal height and shoe size, vaginal cleansing, upright posture for delivery and vaginal lubrication. Unuseful technologies include pelvimetry, estimating fetal weight, early labor induction, routine amniotomy and augmentation, routine episiotomy, and starvation during labor. CONCLUSION: Access to well-established technologies, particularly safe caesarean section, can reduce maternal mortality in resource-poor countries.

Cesarean Section↗
PubMed2005

Validation of traction force indicator in ventouse devices.

OBJECTIVE: To evaluate whether the traction force indicator in a ventouse device gave an accurate estimation of the force applied. METHODS: The study was carried out at the Derby City Hospital. An estimate of measurement errors was made by analyzing the standard deviation of the residuals for 30 Kiwi OmniCup devices (Clinical Innovations, Abingdon, Oxfordshire, England) and a standard industrial spring balance. RESULTS: The measurement errors for the traction forces were very small and acceptable for the OmniCup. The overall estimate of measurement errors was 0.45 kg (1.35 lb). CONCLUSION: The overall measurement error for the traction force indicator of the OmniCup was found to be very small. Injuries associated the ventouse, such as cephalohematomas and subgaleal hemorrhages, may be minimized if the recommended limits for a safe traction force are not exceeded.

Biomechanical Phenomena↗
PubMed2006

Is vacuum extraction still known, taught and practiced? A worldwide KAP survey.

OBJECTIVE: Is vacuum extraction-the method of first choice for assisting vaginal delivery in case of prolonged labor-losing ground in the developing world? And if it is, why? The paper tries to answer these disturbing questions, and examine their consequences. METHODS: A rapid Knowledge-Attitude-Practice (KAP) survey was conducted during 2003-2004 on the question of assisted vaginal delivery (AVD) by the use of the vacuum extractor. Public health specialists and obstetricians from 121 developing countries were consulted about their knowledge of the method in their country, its reputation (i.e. their attitude) and its use (practice). RESULTS: Overall 48% of the respondent countries have confirmed knowledge, positive attitude, teaching and countrywide use of the method, while 37% said the method is known and used by only a limited number of specialists who do not teach it, and 15% admitted no knowledge and therefore no use. CONCLUSION: Given the evidence-based international recognition of the benefits of vacuum extraction (if practiced correctly and for appropriate indications), it is unjust to deprive women with prolonged labor (and their fetuses) of a simple intervention that can contribute to reducing life threatening complications. This unsophisticated worldwide survey, while not providing in-depth explanations, calls for rehabilitation of vacuum extraction in countries where it is disappearing and surgical extraction is not yet readily accessible to all women with prolonged labor.

Clinical Competence↗
PubMed2004

The use of ultrasound for the diagnosis of spinal hemorrhage in a newborn.

We present a case of an unusually large spinal epidural hematoma in an infant after a total breech extraction, which was diagnosed by high-resolution ultrasonography. The lesion appeared unusually large, homogeneous, and isoechoic to the spinal cord. This case demonstrates the ability of ultrasound to diagnose the nature of the lesion, its exact location and full extent. Magnetic resonance imaging was used in this case only as a secondary modality to demonstrate the hemorrhagic nature of the lesion.

Extraction, Obstetrical↗
PubMed1992

Effect of angular traction on the performance of modern vacuum extractors.

OBJECTIVE: Our objective was to describe the effect of off-axis traction on the performance of modern vacuum extractors. STUDY DESIGN: Eight vacuum extractors were examined in the laboratory with a force indicator and fetal cephalic model. Devices evaluated included the 6 cm Malmstrom, Mity-Vac, M-Type, O'Neil, Posterior, Silc, Tender-Touch, and silicone elastomer. Maximal tractive force (pop-off) was measured for each device at 10-degrees increments from the vertical. RESULTS: Multivariate regression analysis described the best model as follows: Maximal tractive force = Constant + Angle + Vacuum (p < 0.05). The partial regression coefficients for angle were negative in all devices except the Posterior cup. At increasing angles of off-axis traction, maximal tractive force decreased in the following order: Silc, silicone elastomer, Tender-Touch, M-Type, Mity-Vac, O'Neill, Malmstrom, and Posterior. CONCLUSIONS: Application of oblique traction resulted in a linear decline in maximal tractive force. An understanding of in vitro performance may allow tailoring of cup selection to the clinical situation.

Evaluation Studies as Topic↗
PubMed1984

Is routine cesarean section necessary for vertex-breech and vertex-transverse twin gestations?

Ninety-three vertex-breech and 42 vertex-transverse twin gestations were managed at Yale-New Haven Medical Center during a 5-year period. Antepartum diagnosis of twin gestation occurred in 93% of the cases, and diagnosis was made before delivery of the second twin in 97% of the cases. Seventy-two (78%) of the vertex-breech and 22 (53%) of the vertex-transverse twins were delivered vaginally. Breech extraction was used for delivery of 76 second twins. Below a birth weight of 1,500 gm, there were six neonatal deaths, four cases of documented intraventricular hemorrhage, and a 67% occurrence of depressed 5-minute Apgar scores. Above a birth weight of 1,500 gm, there were no cases of neonatal death or documented intraventricular hemorrhage and a 5% occurrence of moderately depressed 5-minute Apgar scores. Birth trauma occurred in a 3,420 gm second twin delivered by breech extraction. This infant suffered a greenstick fracture of the right clavicle and a nondisplaced fracture of the right humerus that was not associated with permanent residual injury. We think that, for birth weights greater than 1,500 gm, routine cesarean section for vertex-breech or vertex-transverse twin gestation may not be necessary.

Apgar Score↗
PubMed2002

Astrocytic basic fibroblast growth factor expression in dopaminergic regions after perinatal anoxia.

BACKGROUND: Perinatal anoxia leads to persistent behavioral and neurochemical alterations suggestive of sensitized dopaminergic function. Because astrocytic basic fibroblast growth factor (bFGF) activity in the midbrain dopaminergic cell body region is required for the development of enduring changes in dopaminergic function induced by stimulant drugs, we investigated the effects of intrauterine anoxia on astrocytic bFGF expression in dopaminergic regions at 2 weeks of age and after a stress manipulation in adults. METHODS: We examined bFGF immunoreactivity in dopaminergic regions of young and adult rats born by cesarean section, cesarean section + 15 min of intrauterine anoxia, or vaginally. bFGF immunoreactivity was also assessed before and after tail-pinch stress in adult animals exposed to the same perinatal interventions. RESULTS: Perinatal anoxia produced persistent decreases in basal bFGF immunoreactivity in the ventral tegmental area (VTA), but enhanced the effect of stress on VTA bFGF immunoreactivity. CONCLUSIONS: Perinatal anoxia has enduring effects on VTA bFGF immunoreactivity and influences adult neuroadaptations to stress. The mechanisms whereby perinatal anoxia alters dopaminergic function may be similar to those responsible for the development of sensitization to stimulant drugs and may involve bFGF.

Age Factors↗
PubMed2002

Cephalocentesis with the modified Smellie's perforator.

A 37-year-old pregnant woman, gravida 2, para 0, was referred to Ramathibodi Hospital at 31 weeks of gestation with the diagnosis of hydrocephalus and polyhydramnios. Repeated ultrasound scans revealed hydrocephalus with macrocephaly (BPD=10.3 cm), polyhydramnios (AFI=31.5), and a suspected esophageal atresia. After counseling, both parents decided not to pursue the pregnancy and requested vaginal delivery. They decided against transabdominal, ultrasonic-guided cephalocentesis because of its invasiveness, patient's awareness, and pain. Skull decompression with the modified Smellie's perforator was performed after five 400-microg doses of misoprostol were applied to dilate the cervix. The post-partum condition was uneventful. Fetal skull decompression with the modified Smellie's perforator and misoprostol for cervix dilation is a useful, simple, and safe procedure that can be performed with no previous experience.

Abnormalities, Multiple↗