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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].
Forceps Delivery
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Forceps rotation is associated with severe maternal injuries, including rupture uterus if applied by unskilled hands. It should be attempted under anaesthesia in the operation theatre and should not be attempted if the operator is not trained or skilled in the procedure. There is no role of forceps rotation at higher stations, and this has been replaced with ventouse rotation in the lower stations in modern obstetrics.
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.
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Vaginal delivery in PAH patients should ideally be performed with epidural anesthesia, as this has a limited impact on hemodynamics and reduces pain during labor. Single-shot spinal anesthesia and nitrous oxide should be avoided due to the associated risk of hypotension and increased PVR, respectively [78,79]. Forceps or ventouse devices can assist in delivery and reduce maternal straining during labor [7,80]. If induction of labor is required, caution should be exercised when using oxytocin. A low dose is preferable, as mortality and other adverse outcomes, including intractable arrhythmia and pulmonary hypertensive crisis, have been reported [4,58,65]. Both vaginal and cesarean sections carry their own risks, neither modality offers a perfect solution and decision-making around the mode and timing of delivery should be individualized.
Risk factors associated with breakdown of perineal laceration repair after vaginal birth
Published in Journal of Obstetrics and Gynaecology, 2022
Long Cui, Huizhu Zhang, Lun Li, Chi Chiu Wang
In this study, common risk factors significantly associated with breakdown of perineal laceration included estimated blood loss >500 ml, suspected infection and forceps delivery. Similarly, the operative vaginal birth has been identified as a risk factor in retrospective studies of other populations (Wilkie et al. 2018). However, in contrary to other studies (Jallad et al. 2016; Wilkie et al. 2018), we did not find episiotomy is a risk factor, possibly because of our limited sample size in our study. The association between estimated blood loss >500 ml and breakdown of perineal laceration has been shown previously (Stock et al. 2013). The overall rate of instrumental vaginal birth in our institution was approximately 19.5% during the study period, which is higher than many other institutions. The vast majority of our instrumental vaginal birth were by forceps, which further reinforce the strict clinical indication and use of operative delivery.
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
There was no significant difference in the total vaginal delivery rate when compared between the second dinoprostone pessary and the balloon catheter group (88/177 (48.6%) versus 42/104 (40.4%), p = .1133). However, among the women who successfully achieved vaginal delivery, the delivery rate in the dinoprostone group was significantly higher than that in the balloon catheter within 12 h (14.9% versus 0%, p = .0094), 24 h (48.3% versus 13.2%, p = .0005), 36 h (80.5% versus 60.5% p = .0258) or 48 h (87.4% versus 71.06%, p = .0483) after placement. The mean interval time between the restart of labour induction and vaginal delivery was also significantly shorter in the second dinoprostone group when compared with the balloon catheter group (26.86 ± 15.92 h versus 38.76 ± 21.22 h, p = .0008) as presented in Table 2. Furthermore, the rate of Caesarean Section following induction was 50.3% in the dinoprostone group and 58.6% in the balloon catheter group; there was not statistical difference between the two groups in this respect. Among these, the proportion of urgent Caesarean Sections was 26.0% in the dinoprostone group and 22.1% in the balloon catheter group. The proportion of elective Caesarean Sections was 24.3% in the dinoprostone group and 36.5% in the balloon catheter group. The proportion of participants who underwent forceps vaginal delivery was also similar when compared between the two groups (1.1% in the dinoprostone group versus 1.0% in the balloon catheter group).