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Journal of Gynecology Obstetrics and... May 2022
Topics: Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy
PubMed: 35304291
DOI: 10.1016/j.jogoh.2022.102356 -
European Journal of Obstetrics,... Apr 2022The aim of this study was to assess perinatal morbidity associated with spatulas or forceps assisted delivery in preterm birth.
OBJECTIVE
The aim of this study was to assess perinatal morbidity associated with spatulas or forceps assisted delivery in preterm birth.
STUDY DESIGN
This is a retrospective cohort study including all women with assisted deliveries on singleton pregnancy in cephalic presentation, before 37 weeks of gestation, in two tertiary care centers. We compared forceps-assisted deliveries with spatula-assisted deliveries. The main outcome was the rate of neonatal birth trauma. Secondary outcomes included other neonatal parameters, maternal outcomes and obstetric anal sphincter injuries.
RESULTS
Out of 37 002 deliveries, 59 (0.2 %) preterm assisted deliveries with forceps and 111 (0.3%) preterm spatulas deliveries were included. The rate of neonatal birth trauma was low for both devices, without significant difference (3.4% in Forceps group vs 0.9% in Spatulas group, p = 0.28). The rate of episiotomy was 79.7% after forceps-assisted delivery and 48.6% for spatulas (p < 0.001). The rate of obstetric anal sphincter injuries was 1.7% and 2.7% respectively (p = 0,9).
CONCLUSION
The rate of birth trauma was low in both forceps-assisted deliveries and spatula-assisted deliveries and was not significantly different between the two groups.
Topics: Anal Canal; Delivery, Obstetric; Episiotomy; Female; Humans; Infant, Newborn; Morbidity; Obstetrical Forceps; Pregnancy; Premature Birth; Retrospective Studies; Surgical Instruments
PubMed: 35183002
DOI: 10.1016/j.ejogrb.2022.02.007 -
Female Pelvic Medicine & Reconstructive... Feb 2022The objective of this study is to evaluate factors associated with obstetric anal sphincter injury and identify modifiable risks.
OBJECTIVE
The objective of this study is to evaluate factors associated with obstetric anal sphincter injury and identify modifiable risks.
METHODS
A retrospective case-control study was performed in women who gave birth at our institution between May 2008 and December 2012. Patients who had a third- or fourth-degree lacerations were compared with those who did not. Parity, stretch marks, age, body mass index, tobacco use, fetal weight, operative delivery, labor, and second stage duration were compared between groups. Multivariate direct logistic regression was conducted on all patients who had complete data to calculate the adjusted odds ratio.
RESULTS
We identified 299 patients with third- or fourth-degree lacerations and 8,459 patients without third- or fourth-degree lacerations during the time frame. Duration of second stage between 1 hour and 2 hours (P < 0.0001), duration of second stage greater than 2 hours (P < 0.0001), midline or unknown type episiotomy (P < 0.0001), mediolateral episiotomy (P < 0.0001), vacuum delivery (P < 0.0001), forceps delivery (P < 0.0001), fetal weight greater than 4,000 g (P < 0.0001), and antepartum stress urinary incontinence (P < 0.006) were associated with a significant increase in high-risk lacerations. This study did not find a statistically significant association between parity and these lacerations.
CONCLUSIONS
We, as others, found that episiotomy and operative delivery were modifiable risks of obstetrical care. Furthermore, even a short second stage of labor (1-2 hours) was associated with significant risk of injury.
Topics: Anal Canal; Case-Control Studies; Delivery, Obstetric; Episiotomy; Female; Humans; Lacerations; Obstetric Labor Complications; Perineum; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35084370
DOI: 10.1097/SPV.0000000000001077 -
Journal of Obstetrics and Gynaecology... Jun 2022To achieve expert consensus using the Delphi methodology on the sub-steps considered essential in an outlet forceps-assisted vaginal delivery (FAVD). The purpose of this...
OBJECTIVE
To achieve expert consensus using the Delphi methodology on the sub-steps considered essential in an outlet forceps-assisted vaginal delivery (FAVD). The purpose of this work is to help inform a framework for standardized training and objective assessment in the procedure.
METHODS
A Delphi survey was conducted with an international panel of experts in FAVD. Using an online platform, experts rated sub-steps of FAVD on a 5-point Likert scale to indicate whether they considered them essential. Responses were returned to the panel until consensus was reached (Cronbach α ≥ 0.80) with an intraclass correlation coefficient ≥0.75. All sub-steps with a rate of agreement ≥80% are proposed to be included in a future evaluation instrument.
RESULTS
After the first iteration of the Delphi procedure, a response rate of 42% was reached (n = 21); the second iteration was only sent to those who had participated in the initial iteration, reaching a response rate of 100%. Of 42 sub-steps rated in the first round, 24 (57.1%) achieved consensus, 8 (19%) were rejected, and 10 (23.8%) were re-rated in the second round. After 2 iterations, 28 sub-steps were agreed upon by the experts to be essential in FAVD.
CONCLUSIONS
A panel of experts identified a total of 28 sub-steps essential to FAVD. This list could inform the development of an objective assessment framework and evaluation tool for this procedure. Further research should focus on the standardization, applicability, validation, and introduction of this tool in medical training, with a focus on real-life, high-fidelity simulation and online educational tools.
Topics: Consensus; Delivery, Obstetric; Delphi Technique; Female; Humans; Pregnancy; Surgical Instruments
PubMed: 35074484
DOI: 10.1016/j.jogc.2022.01.008 -
European Journal of Obstetrics,... Mar 2022Data regarding the risk factors for obstetrical anal sphincter injury (OASI) among nulliparous adolescent women are scarce. We aimed to evaluate these risk factors.
OBJECTIVE
Data regarding the risk factors for obstetrical anal sphincter injury (OASI) among nulliparous adolescent women are scarce. We aimed to evaluate these risk factors.
STUDY DESIGN
A retrospective case-control study of nulliparous women aged ≤ 21 who delivered vaginally between 3/2011 and 6/2021. Maternal and intrapartum characteristics were compared between OASI and no-OASI groups.
RESULTS
Of 1,342 deliveries, 22 (1.6%) cases of OASI were diagnosed. Maternal anthropometric and demographic characteristics did not vary between study groups. Gestational comorbidity (diabetic and hypertensive disorders) was associated with an increased risk for an OASI [OR 95% CI 3.1 (1.1-8.6)]. The rate of prolonged second stage was associated with an OASI [OR 95% CI 2.5 (1.1-6.5)]. The mode of delivery was similar in both groups. There were no forceps deliveries in the OASI group. Birthweight and the proportion of newborns weighing more than 4,000 g were similar in both study groups. All sonographic biometric measurements did not vary between study groups. Women with an OASI had higher rate of blood transfusion [OR 95% CI 11.4 (3.1-42.0)]. In a multivariable regression analysis, including birthweight, vacuum assisted delivery, prolonged second stage and gestational comorbidity - gestational comorbidity was the only independent factor associated with the occurrence of an OASI [adjusted OR 95% CI 2.9 (1.05-8.17)].
CONCLUSION
Gestational comorbidity is the only predictor of OASI among nulliparous adolescent women.
Topics: Adolescent; Aged; Anal Canal; Case-Control Studies; Delivery, Obstetric; Female; Humans; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35063898
DOI: 10.1016/j.ejogrb.2022.01.009 -
BMC Pregnancy and Childbirth Jan 2022The potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery... (Observational Study)
Observational Study
Mediolateral episiotomy and risk of obstetric anal sphincter injuries and adverse neonatal outcomes during operative vaginal delivery in nulliparous women: a propensity-score analysis.
BACKGROUND
The potential protective effect of mediolateral episiotomy for obstetrical anal sphincter injuries (OASIs) remains controversial during operative vaginal delivery because of the difficulties to take into account the risk factors and clinical conditions at delivery; in addition, little is known about the potential benefits of mediolateral episiotomy on neonatal outcomes. The objectives were to investigate the associations between mediolateral episiotomy and both OASIs and neonatal outcomes, using propensity scores.
METHODS
We performed a retrospective population-based observational study from a perinatal registry that includes all births in a French region between 2010 and 2017. All nulliparous women with singleton pregnancy delivering by operative vaginal deliveries at 37 weeks gestational age or later were included. Inverse-probability-of-treatment weighting with propensity scores was used to minimize indication bias. OASIs was defined as third and fourth-degree tears according to Royal College of Obstetricians and Gynecologists. Two neonatal outcomes were studied: condition at birth (5-min Apgar score less than 7 and/or umbilical artery pH less than 7.10), and admission to neonatal intensive care unit.
RESULTS
The study population consisted of 7589 women; 2880 (38.0%) received mediolateral episiotomy. After applying propensity scores, episiotomy was associated with a lower rate of OASIs in forceps/spatula delivery (2.3 vs 6.8%, Risk Ratio (RR) 0.38, 95% Confidence Interval (CI) 0.28-0.52) and in vacuum delivery (1.3 vs 3.4%, RR 0.27, 95% CI 0.20-0.38) as compared with no episiotomy. Mediolateral episiotomy was associated with better condition at birth in case of forceps/spatula delivery (4.5 vs 8.8%, RR 0.56, 95% CI 0.39-0.81). In cases of fetal distress (40.7%), mediolateral episiotomy was associated with better condition of infant at birth in women who delivered by forceps/spatula (4.2 vs 13.5%, RR 0.52, 95% CI 0.31-0.89). No association was found with neonatal unit admission (RR 0.93, 95% CI 0.50-1.74).
CONCLUSIONS
Use of mediolateral episiotomy was associated with a lower rate of OASIs during operative vaginal delivery, and in infants it was associated with better condition at birth following forceps/spatula delivery.
Topics: Anal Canal; Apgar Score; Delivery, Obstetric; Episiotomy; Female; Fetal Distress; France; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Odds Ratio; Parity; Pregnancy; Propensity Score; Retrospective Studies
PubMed: 35045812
DOI: 10.1186/s12884-022-04396-6 -
International Urogynecology Journal Jun 2022Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective...
INTRODUCTION AND HYPOTHESIS
Obstetrical anal sphincter injury (OASIS) is a common consequence of vaginal delivery in nulliparas and carries the risk of short- and long-term morbidity. The objective of this study was to estimate the association between the duration of the second stage of labour and OASIS risk.
METHODS
A population-based, retrospective cohort of nulliparas delivering singleton, vertex, non-anomalous fetuses at term in Nova Scotia, Canada, from 2005 to 2019, were identified using the Nova Scotia Atlee Perinatal Database. Poisson regression models were used to estimate risk ratios (RR) with robust 95% confidence intervals (CI) adjusting for confounding variables to investigate the association between the length of the second stage and OASIS in the entire cohort and in operative vaginal deliveries.
RESULTS
Of 36,662 participants, 7.6% sustained an OASIS (6.8% third-degree, 0.8% fourth-degree tear). The proportion of participants who sustained an OASIS increased over the study period. For each 30-min increase in the length of second stage, the OASIS risk increased by 11% (RR 1.11, 95% CI 1.10-1.12). When stratified by mode of delivery, second stage length ≥ 90 min was associated with an increased OASIS risk in spontaneous (RR 1.35, 95% CI 1.15-1.58) and vacuum-assisted vaginal deliveries (RR 1.42, 95% CI 1.11-1.81). In forceps-assisted vaginal deliveries, OASIS risk was increased, with shorter and longer durations of the second stage.
CONCLUSION
Increasing length of the second stage of labour was associated with increasing risk of OASIS overall, but the association was heterogeneous between modes of delivery. Length of the second stage should be considered in counseling about OASIS risk.
Topics: Anal Canal; Cohort Studies; Delivery, Obstetric; Female; Humans; Labor Stage, Second; Obstetric Labor Complications; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 35020035
DOI: 10.1007/s00192-021-05070-9 -
CMAJ : Canadian Medical Association... Jan 2022Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts...
BACKGROUND
Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume.
METHODS
We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression.
RESULTS
Of 1 326 191 deliveries, 38 500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for confounders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care.
INTERPRETATION
In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
Topics: Anal Canal; Birth Injuries; Canada; Female; Humans; Incidence; Intracranial Hemorrhages; Lacerations; Neonatal Brachial Plexus Palsy; Obstetric Labor Complications; Obstetrical Forceps; Pelvis; Pregnancy; Skull Fractures; Trauma, Nervous System; Urethra; Urinary Bladder; Vacuum Extraction, Obstetrical; Vagina
PubMed: 35012946
DOI: 10.1503/cmaj.210841 -
Indian Journal of Ophthalmology Dec 2021Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant... (Review)
Review
Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.
Topics: Adult; Astigmatism; Child; Child, Preschool; Corneal Edema; Corneal Topography; Descemet Membrane; Female; Humans; Infant, Newborn; Obstetrical Forceps; Pregnancy
PubMed: 34826970
DOI: 10.4103/ijo.IJO_863_21 -
PloS One 2021Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of... (Comparative Study)
Comparative Study
Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications.
BACKGROUND
Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries.
STUDY DESIGN
Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student's t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant.
RESULTS
Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41-15.56, p< 0.001).
CONCLUSION
In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.
Topics: Adult; Cesarean Section; Female; Hospitals, University; Humans; Labor Onset; Maternal Age; Obstetric Labor Complications; Obstetrical Forceps; Pregnancy; Prospective Studies; Tertiary Care Centers; Vacuum Extraction, Obstetrical
PubMed: 34784382
DOI: 10.1371/journal.pone.0259926