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Best Practice & Research. Clinical... Apr 2019This chapter will cover the evolution of forceps and vacuum-assisted delivery of the foetus in cephalic presentation. The options available before the development of... (Review)
Review
This chapter will cover the evolution of forceps and vacuum-assisted delivery of the foetus in cephalic presentation. The options available before the development of obstetric forceps are briefly reviewed. The invention of the forceps in the early 17th century was followed by their evolution over four centuries with the introduction of the pelvic curve, axis-traction and rotational forceps. The phase of prophylactic forceps delivery will be discussed. The development of vacuum-assisted delivery has evolved over the past 150 years. However, in practical terms, the modern era of vacuum-assisted delivery began with Tage Malmström's vacuum extractor in the early 1950s. The evolution of the modern vacuum extractor with metal, soft and hard plastic cups will be reviewed.
Topics: Extraction, Obstetrical; Female; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Obstetrical Forceps; Pregnancy; Vacuum Extraction, Obstetrical
PubMed: 30253921
DOI: 10.1016/j.bpobgyn.2018.08.002 -
BMJ (Clinical Research Ed.) Oct 2023argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action
argue that Canada’s high rates of maternal and neonatal trauma following operative vaginal delivery warrant urgent recognition, transparency, and action
Topics: Pregnancy; Infant, Newborn; Female; Humans; Vacuum Extraction, Obstetrical; Infant, Newborn, Diseases; Birth Injuries; Family; Surgical Instruments; Obstetrical Forceps; Delivery, Obstetric; Extraction, Obstetrical; Retrospective Studies
PubMed: 37857419
DOI: 10.1136/bmj-2022-073991 -
Best Practice & Research. Clinical... Apr 2019Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical... (Review)
Review
Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less foetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.
Topics: Contraindications, Procedure; Dystocia; Episiotomy; Extraction, Obstetrical; Female; Humans; Infant, Newborn; Labor Stage, Second; Obstetrical Forceps; Perineum; Postpartum Hemorrhage; Pregnancy; Urinary Incontinence; Version, Fetal; Wounds and Injuries
PubMed: 30827815
DOI: 10.1016/j.bpobgyn.2019.02.002 -
The Cochrane Database of Systematic... Aug 2017Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to... (Review)
Review
BACKGROUND
Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.
OBJECTIVES
To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach.
MAIN RESULTS
One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay.
AUTHORS' CONCLUSIONS
One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
Topics: Antibiotic Prophylaxis; Endometritis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Puerperal Infection; Randomized Controlled Trials as Topic; Vacuum Extraction, Obstetrical; Vaginal Diseases
PubMed: 28779515
DOI: 10.1002/14651858.CD004455.pub4 -
Best Practice & Research. Clinical... Apr 2019Skilled, safe operative vaginal birth can substantially improve maternal and neonatal outcomes arising from complications in the second stage of labour and should be... (Review)
Review
Skilled, safe operative vaginal birth can substantially improve maternal and neonatal outcomes arising from complications in the second stage of labour and should be available in a diverse range of maternity settings for women across the world. Operative vaginal births are complex, requiring a combination of good technical skills, non-technical skills as well as sensitivity from the accoucher. It is axiomatic that accouchers should be adequately trained and simulation-based training is a promising strategy to improve outcomes and increase the rates of operative vaginal birth. However, not all training is effective and although there are likely to be important lessons from other areas of simulation-based obstetric emergencies training that are generalisable, more research is required to identify effective training interventions for operative vaginal birth. Training for operative vaginal birth should also be operationalised for maximum spread and benefit.
Topics: Clinical Competence; Delivery, Obstetric; Extraction, Obstetrical; Female; Humans; Manikins; Obstetrical Forceps; Obstetrics; Pregnancy; Simulation Training
PubMed: 30447884
DOI: 10.1016/j.bpobgyn.2018.10.001 -
Best Practice & Research. Clinical... Apr 2019During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum... (Review)
Review
During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum infection is caesarean section; 20-25% of operations are followed by wound infections, endometritis or urinary tract infections. Approximately 13% of women in the UK undergo operative vaginal delivery (OVD) with forceps or vacuum, which is also associated with an increased risk of infection, estimated at 0.7%-16% of these deliveries. Despite this, previous reviews have identified only one small trial of antibiotic prophylaxis in 393 women and concluded that there was insufficient evidence to support the routine use of prophylactic antibiotics after OVD. The ANODE trial, a multicentre, blinded, placebo-controlled trial from the UK, is due to report findings from more than 3400 women in 2019 and will be the largest study to date of antibiotic prophylaxis following OVD.
Topics: Antibiotic Prophylaxis; Endometritis; Extraction, Obstetrical; Female; Humans; Perineum; Pregnancy; Puerperal Disorders; Risk Factors; Sepsis; Urinary Tract Infections; Wound Infection
PubMed: 30992125
DOI: 10.1016/j.bpobgyn.2018.09.005 -
American Journal of Obstetrics &... Nov 2021This review presents the available data on the diagnosis of obstetrical anal sphincter injury by postnatal ultrasound imaging. There is increasing evidence that anal... (Review)
Review
This review presents the available data on the diagnosis of obstetrical anal sphincter injury by postnatal ultrasound imaging. There is increasing evidence that anal sphincter tears are often missed after childbirth and, even when diagnosed, often suboptimally repaired, with a high rate of residual defects after reconstruction. Even after postpartum diagnosis and primary repair, 25% to 50% of patients will have persistent anal incontinence. As clinical diagnosis may fail in the detection and classification of obstetrical anal sphincter injury, the use of imaging has been proposed to improve the detection and treatment of these lacerations. Notably, 3-dimensional endoanal ultrasound is considered the gold standard in the detection of obstetrical anal sphincter injury, and recently, 4-dimensional transperineal ultrasound, commonly available in obstetrical and gynecologic settings, has proven to be effective as well. Avoidance of forceps delivery when possible, performance of a rectal examination after vaginal delivery and before repair of any severe perineal tear, and offering sonographic follow-up at 10 to 12 weeks after vaginal delivery in high-risk women (maternal age of ≥35 years, vaginal birth after cesarean delivery, forceps, prolonged second stage of labor, overt obstetrical anal sphincter injury, shoulder dystocia, and macrosomia) may help reduce morbidity arising from anal sphincter tears.
Topics: Adult; Anal Canal; Female; Humans; Lacerations; Perineum; Postpartum Period; Pregnancy; Ultrasonography
PubMed: 34129995
DOI: 10.1016/j.ajogmf.2021.100421 -
Obstetrics and Gynecology Mar 2015Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is...
Persistent occiput posterior (OP) is associated with increased rates of maternal and newborn morbidity. Its diagnosis by physical examination is challenging but is improved with bedside ultrasonography. Occiput posterior discovered in the active phase or early second stage of labor usually resolves spontaneously. When it does not, prophylactic manual rotation may decrease persistent OP and its associated complications. When delivery is indicated for arrest of descent in the setting of persistent OP, a pragmatic approach is suggested. Suspected fetal macrosomia, a biparietal diameter above the pelvic inlet or a maternal pelvis with android features should prompt cesarean delivery. Nonrotational operative vaginal delivery is appropriate when the maternal pelvis has a narrow anterior segment but ample room posteriorly, like with anthropoid features. When all other conditions are met and the fetal head arrests in an OP position in a patient with gynecoid pelvic features and ample room anteriorly, options include cesarean delivery, nonrotational operative vaginal delivery, and rotational procedures, either manual or with the use of rotational forceps. Recent literature suggests that maternal and fetal outcomes with rotational forceps are better than those reported in older series. Although not without significant challenges, a role remains for teaching and practicing selected rotational forceps operations in contemporary obstetrics.
Topics: Extraction, Obstetrical; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy
PubMed: 25730235
DOI: 10.1097/AOG.0000000000000647 -
Ceska Gynekologie 2020An overview of urinary incontinence issues after vaginal delivery versus instrumental delivery. (Review)
Review
OBJECTIVE
An overview of urinary incontinence issues after vaginal delivery versus instrumental delivery.
DESIGN
A review article.
METHODS
Compilation of published data from scientific literature.
SETTING
Ústav pro studium odborných předmětů a praktických dovedností, Fakulta zdravotnických věd, Univerzita Palackého v Olomouci. Centrum vědy a výzkumu, Fakulta zdravotnických věd, Univerzita Palackého v Olomouci.
CONCLUSION
Pregnancy and childbirth can lead to injuries of the pelvic floor muscles. The age of the firstborn in the pelvic floor disorders is similar to that of the end of pregnancy. Surgical vaginal delivery is an important part of modern obstetric practice. This serves to facilitate the delivery of the head. Includes vacuumextraction (VEX) and forceps. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma.
Topics: Delivery, Obstetric; Female; Humans; Pelvic Floor; Pelvic Floor Disorders; Pregnancy; Risk Factors; Urinary Incontinence; Vacuum Extraction, Obstetrical
PubMed: 33562983
DOI: No ID Found -
Bratislavske Lekarske Listy 2019This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors. (Observational Study)
Observational Study
OBJECTIVES
This study was conducted to determine the frequency of increased postvoiding residual volumes (PVRV) 3 days after delivery and to examine the associated risk factors.
BACKGROUND
Increased PVRV ‒ covert postpartum urinary retention, is an asymptomatic condition with possible long-term adverse effects. While early diagnosis and appropriate management can avoid long‑term complications, screening is not routinely performed. By identifying risk factors, we could define the group of patients suitable for screening.
MATERIAL AND METHODS
This was a prospective observational study carried out over a 3-month period at the university teaching hospital in Bratislava, Slovakia. All participants underwent ultrasound determination of PVRV while 80 ml and more on day 3 was considered pathological.
RESULTS
A total of 429 women were included in the study. The prevalence of covert post-partum urinary retention was 9.2 %. Assisted vaginal delivery (ventouse, forceps) and episiotomy were risk factors for post-partum urinary retention (18.7 % vs 6.1 %; p = 0.0053; 52.1 % vs 35.7 %; p = 0.0483; respectively).
CONCLUSION
Our observations confirmed the existence of PVRV of 80 ml and more on day 3 in almost 10% of women who had delivered at our clinic. The results of our study prove that instrumental delivery represents a considerable obstetrical-pediatric risk factor for PVRV. Our data support the need of adopting a risk-factor-based approach to PVRV screening as part of postpartum bladder care (Tab. 2, Fig. 1, Ref. 12).
Topics: Delivery, Obstetric; Female; Humans; Postpartum Period; Pregnancy; Prospective Studies; Risk Factors; Slovakia; Urinary Retention
PubMed: 31475552
DOI: 10.4149/BLL_2019_112