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Operative Vaginal Delivery
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Adeeb Khalifeh, Megan Piacquadio
“Elective” forceps delivery, that is, without an indication, is associated with increased maternal perineal trauma and, given the other potential maternal and neonatal complications, should not be preferred to spontaneous vaginal delivery [5].
Instrumental Vaginal Delivery
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Malik Goonewardene, Sanjeewa Padumadasa
The basic premise of a vacuum extractor is that a suction cup is connected, via tubing to a vacuum source. Direct traction can then be applied to the presenting part, either directly through the tubing or via a connecting chain. Recently introduced devices have incorporated the vacuum mechanism into handheld cups. Although the risk of maternal genital tract injuries is less in this procedure rather than with a forceps delivery, the risk of fetal injury is akin to that of a forceps delivery. The clinical assessment before vacuum delivery should be just as stringent as for rotational forceps, and the same prerequisites should be fulfilled for a vacuum delivery. Vacuum delivery is best avoided if a fetal bleeding disorder is suspected or at gestations less than 34 weeks due to the risk of haemorrhage in the fetus.
Instrumental delivery
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
For another woman the account of her daughter’s delivery was more worrying, although again the story as told by the woman and her partner was not reflected by the hospital documentation. A forceps delivery was required, again because of fetal heart rate abnormalities, and initially the delivery was conducted by a middle-grade obstetrician with supervision from the consultant. When the baby’s head did not descend the consultant took over the delivery, and pulled much harder. A very strong operating department practitioner held the woman steady on the bed to prevent her whole body being pulled down and off the bed as the consultant pulled on the forceps. Eventually the baby was delivered, and after some quick initial resuscitation she recovered well. When she was a few months old, she started waking in the night screaming. Whilst any other parent would have attributed this to teething, her parents worried that it was to do with some form of brain damage linked to her delivery. The baby underwent a series of investigations, the results of which were all normal, but it was a very long time before the parents’ fears could be allayed.
The efficacy and safety of second dinoprostone pessary or balloon catheter after unsuccessful primary ripening with dinoprostone pessary
Published in Journal of Obstetrics and Gynaecology, 2022
Dongli Sun, Qiaoai Wu, Xinfan Wang, Fengmei Wang
Information relating to the mechanism of induction method was given to each woman prior to IOL. We also discussed the risks and benefits of the trial to continue IOL. Labour was managed by the obstetricians and midwives according to the standard protocol of the Women’s Hospital. Digital cervical examination was performed before induction and the Bishop Score was recorded. A dinoprostone pessary or balloon catheter was used for cervical ripening if the score was lower than 6 points, according to the clinical decisions of the attending obstetrics physician. The balloon catheter was inserted trans-cervically and filled with up to 150 ml of saline and left for 16 h. The balloon was removed if the amniotic membranes ruptured, the patient experienced the onset of active labour, or the foetal heart rate showed abnormal changes. The dinoprostone pessary was inserted in the posterior fornix of the vagina and remained in place for 24 h according to the manufacturer’s guidelines but was removed upon the onset of active labour or the occurrence of adverse events. An emergency Caesarean Section or forceps delivery was carried out mainly due to foetal distress. An elective Caesarean Section was performed when the induction of labour failed; this was defined as failure to enter the active phase of labour within 24 h of removing the dinoprostone pessary or the balloon catheter.
The rs2165241 polymorphism of the Loxl1 gene in postmenopausal women with pelvic organ prolapse
Published in Climacteric, 2022
C. L. Costa e Silva, M. A. T. Bortolini, N. C. Batista, R. S. P. Silva, J. B. Teixeira, É. Oliveira, R. P. Souto, R. A. Castro
There is by far the recognition that obstetric variables are the major determinants for POP [23–26]. In our study, women with POP had higher parity, and vaginal delivery was the main independent risk factor for POP with a 13‐fold increased chance of POP development in women who had at least one vaginal delivery. Also, cesarean delivery proved to be a protective factor in our sample of patients. These findings agree with the more recent systematic review by Cattani et al. that included 108 studies, which confirmed a strong etiological link between vaginal birth and POP, with the first vaginal delivery (odds of risk up to 4.85) and forceps delivery (odds for risk up to 2.51) being the main determinants, while cesarean was protective for POP (odds for risk up to 0.38) [6]. However, our study failed to detect forceps delivery as associated with POP, perhaps due to the low rate of instrumental use (around 22%) in our population.
The BD Odon Device™: an update of its current state
Published in Journal of Obstetrics and Gynaecology, 2021
Manuel Gonçalves-Henriques, Pedro Brandão
In 2017, O’Brien published the first three studies about the application of BD Odon Device™ in mannequins. One of them aimed to evaluate the interaction between health providers and the device. This study demonstrated that some modifications to the first model of the device as well as providing specific training to practitioners prior to its use—instruction for use, training video and one-to-one training—improved the percentage of correct use from 25 to 100% in all three main steps—preparation of the device, application and completing delivery (O’Brien et al. 2017a). Another study evaluated the sitting position of the device, its movement during delivery and the degree of perineal distension. The device was reliably sited in average over the foetal head position and the degree of perineal distension was similar to vacuum extraction of forceps delivery (O’Brien et al. 2017b). The third study evaluated the pressure and traction forces exerted by the BD Odon Device™ compared to forceps or Kiwi® vacuum extractor during simulated births. The perineal distention generated by the BD Odon Device™ was greater than ventouse but less than forceps (O’Brien et al. 2017c).