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International Urogynecology Journal Sep 2021Damage to the pelvic floor during pregnancy and vaginal delivery is an inevitable consequence of the natural birthing process. As this damage is associated with...
Damage to the pelvic floor during pregnancy and vaginal delivery is an inevitable consequence of the natural birthing process. As this damage is associated with functional and anatomical problems in later life, minimizing pelvic floor damage during pregnancy and vaginal delivery may serve as an important factor in the prevention of these unwanted sequelae. Operative vaginal delivery using forceps or vacuum extractor is common practice to achieve or expedite vaginal birth for maternal or fetal indications such as maternal exhaustion or fetal distress. However, operative vaginal delivery is associated with more extensive damage to the pelvic floor and perineal structures with forceps carrying a stronger risk compared to vacuum. The evidence on this subject is discussed with possible suggestions to minimize pelvic floor damage as much as possible.
Topics: Delivery, Obstetric; Fecal Incontinence; Female; Goals; Humans; Obstetrical Forceps; Perineum; Pregnancy; Surgical Instruments
PubMed: 34076719
DOI: 10.1007/s00192-021-04866-z -
BJOG : An International Journal of... Mar 2022There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors.
BACKGROUND
There is variation in the reported incidence rates of levator avulsion (LA) and paucity of research into its risk factors.
OBJECTIVE
To explore the incidence rate of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion.
SEARCH STRATEGY
We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019.
STUDY ELIGIBILITY CRITERIA
A study was included if LA was assessed by an imaging modality after the first vaginal birth or caesarean section. Case series and reports were not included.
DATA COLLECTION AND ANALYSIS
RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages were used for type and timing of imaging analyses.
RESULTS
We included 37 primary non-randomised studies from 17 countries and involving 5594 women. Incidence rates of LA were 1, 15, 21, 38.5 and 52% following caesarean, spontaneous, vacuum, spatula and forceps births, respectively, with no differences by imaging modality. Odds ratio of LA following spontaneous birth versus caesarean section was 10.69. The odds ratios for LA following vacuum and forceps compared with spontaneous birth were 1.66 and 6.32, respectively. LA was more likely to occur unilaterally than bilaterally following spontaneous (P < 0.0001) and vacuum-assisted (P = 0.0103) births but not forceps. Incidence was higher if assessment was performed in the first 4 weeks postpartum.
CONCLUSIONS
LA incidence rates following caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively. Ultrasound and magnetic resonance imaging were comparable tools for LA diagnosis.
TWEETABLE ABSTRACT
Levator avulsion incidence rates after caesarean, spontaneous, vacuum and forceps deliveries were 1, 15, 21 and 52%, respectively.
Topics: Cesarean Section; Female; Humans; Incidence; Pelvic Floor Disorders; Pregnancy; Vacuum Extraction, Obstetrical
PubMed: 34245656
DOI: 10.1111/1471-0528.16837 -
Obstetrics and Gynecology Sep 2016
Topics: Humans; Obstetrical Forceps; Social Media; Surgical Instruments
PubMed: 27500322
DOI: 10.1097/AOG.0000000000001612 -
Best Practice & Research. Clinical... Apr 2019Operative vaginal delivery (OVD) is associated with injury to the pelvic floor and compromise to the urinary, genital and gastrointestinal systems. There has been... (Review)
Review
Operative vaginal delivery (OVD) is associated with injury to the pelvic floor and compromise to the urinary, genital and gastrointestinal systems. There has been significant evolution in recent years in the practice of OVD (from the use of forceps to vacuum delivery), the conduct of delivery (from routine to selective episiotomy) and the recognition and management of obstetric anal sphincter injury (OASIS). This review article considers a number of key questions from the perspective of the clinical practitioner: What effects does OVD have on the pelvic floor? How can the effects of OVD on the pelvic floor be reduced? When and how should episiotomy be performed during OVD? How should future pregnancies following OVD and OASIS be managed? The place of episiotomy during OVD, a much debated strategy to prevent injury to the obstetric anal sphincter during OVD, is considered.
Topics: Dyspareunia; Episiotomy; Extraction, Obstetrical; Fecal Incontinence; Female; Humans; Pelvic Pain; Perineum; Practice Guidelines as Topic; Pregnancy; Urinary Incontinence
PubMed: 30850327
DOI: 10.1016/j.bpobgyn.2019.01.013 -
The Cochrane Database of Systematic... Oct 2014Vacuum 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 the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014).
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. For this update, we assessed methodological quality of the one included trial using the standard Cochrane criteria and the GRADE approach. We calculated the risk ratio (RR) and mean difference (MD) using a fixed-effect model and all the review authors interpreted and discussed the results.
MAIN RESULTS
One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21). 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). Overall, the risk of bias was judged as low. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay.
AUTHORS' CONCLUSIONS
The data were too few to make any recommendations for practice. 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: 25308837
DOI: 10.1002/14651858.CD004455.pub3 -
European Journal of Obstetrics,... Jan 2021Obstetric forceps were invented in the 1600s to assist vaginal delivery of term babies following prolonged labour. This probably explains their design, with a narrow... (Review)
Review
Obstetric forceps were invented in the 1600s to assist vaginal delivery of term babies following prolonged labour. This probably explains their design, with a narrow interblade distance and long blade length, to fit a severely moulded fetal head. However, in modern obstetric practice protracted labour is avoided, yet our research has shown that over 400 years forceps dimensions have remained largely unchanged. We believe it is time to optimise these dimensions based on biometry of the term, newborn baby's head, with the head width (biparietal diameter) and head length (mentovertical diameter) correlating with interblade distance and blade length respectively. We hypothesise that doing so should reduce the incidence of neonatal complications associated with forceps assisted delivery and it is also possible that the amended shape might be associated with better outcomes for women. In this article we present our rationale for the optimisation of the forceps dimensions based on the findings of our previous systematic review and an original series of mentovertical and biparietal diameter measurements using laser scanning technology.
Topics: Biometry; Delivery, Obstetric; Female; Head; Humans; Infant, Newborn; Labor, Obstetric; Obstetrical Forceps; Pregnancy
PubMed: 33259995
DOI: 10.1016/j.ejogrb.2020.11.046 -
American Family Physician Oct 2020
Review
Topics: Adult; Antibiotic Prophylaxis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Prenatal Care; Puerperal Disorders; Randomized Controlled Trials as Topic; Surgical Wound Infection; Vacuum Extraction, Obstetrical
PubMed: 32996760
DOI: No ID Found -
Clinical Obstetrics and Gynecology Jun 2015Although the number of cesarean deliveries increased from 23% to 34.7% between 1996 and 2006, forceps and vacuum use declined, from 6.3% to 1.7% and 6.8% to 5.5%,... (Review)
Review
Although the number of cesarean deliveries increased from 23% to 34.7% between 1996 and 2006, forceps and vacuum use declined, from 6.3% to 1.7% and 6.8% to 5.5%, respectively. When spontaneous vaginal delivery in the second stage of labor is not a possibility, operative vaginal delivery may be a safe, acceptable alternative to cesarean delivery. We explore indications for operative deliveries and the benefits and risks as compared with cesarean. In addition, we review the barriers to forceps and vacuum use and the importance of continued training to increase the number of providers who are able to safely perform these skills.
Topics: Cesarean Section; Female; Humans; Labor Stage, Second; Obstetric Labor Complications; Obstetrical Forceps; Patient Selection; Pregnancy; Pregnancy Outcome; Risk Adjustment; Risk Assessment; Vacuum Extraction, Obstetrical
PubMed: 25811126
DOI: 10.1097/GRF.0000000000000104 -
European Journal of Obstetrics,... May 2017Rotational forceps and manual rotation followed by direct forceps are techniques used in the management of malposition of the fetal head in the second stage of labor.... (Comparative Study)
Comparative Study
OBJECTIVE
Rotational forceps and manual rotation followed by direct forceps are techniques used in the management of malposition of the fetal head in the second stage of labor. However, there is widespread debate regarding their relative safety and utility. We aimed to compare the effectiveness and safety of rotational forceps with manual rotation followed by direct forceps, for management of fetal malposition at full dilation.
STUDY DESIGN
A retrospective cohort study in a single tertiary obstetric unit with >6000 births per year. We recorded and analysed outcomes of 104 sequential rotational forceps births over 21 months (Jan 2010-Sept 2012) and 208 matched chronologically sequential attempted manual rotations and direct forceps births (1:2 by number). Univariable and multivariable approaches used for statistical analysis. The main outcome measure was vaginal birth.
RESULTS
The rate of vaginal birth was significantly higher with rotational forceps than with manual rotation followed by direct forceps (88.5% vs 82.2%, RR 1.17, 95% CI 1.04-1.31, p=0.017). Births by rotational forceps were associated with a significantly higher rate of shoulder dystocia (19.2% vs 10.6%, RR 2.35, 95% CI 1.23-4.47, p=0.012), but not of neonatal injury. There were no significant differences in all other maternal and neonatal outcomes between the two modes of birth.
CONCLUSIONS
The use of rotational forceps was associated with a statistically significantly higher rate of vaginal birth, but also of shoulder dystocia, compared to manual rotation followed by direct forceps. This is the first study to demonstrate a statistically significant increase in the rate of shoulder dystocia following rotational forceps birth.
Topics: Adult; Birth Injuries; Delivery, Obstetric; Dystocia; Female; Humans; Infant, Newborn; Labor Presentation; Labor Stage, Second; Obstetrical Forceps; Pregnancy; Retrospective Studies; Shoulder
PubMed: 28351816
DOI: 10.1016/j.ejogrb.2017.03.031 -
Journal of Obstetrics and Gynaecology... Mar 2024
Topics: Pregnancy; Female; Humans; Delivery, Obstetric; Extraction, Obstetrical; Surgical Instruments; Canada; Obstetrical Forceps; Vacuum Extraction, Obstetrical
PubMed: 38548448
DOI: 10.1016/j.jogc.2023.102325