Instrumental delivery
Sheila Broderick, Ruth Cochrane in Trauma and Birth, 2020
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.
Operative Vaginal Delivery
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
NeonatalIntracranial hemorrhage rate is increased in OVD, but the absolute risk is low [19].The rates of intracranial hemorrhage and neonatal encephalopathy compared to second-stage CD are similar [19, 20].Cephalohematoma, fetal scalp lacerations, retinal hemorrhages, subgaleal hematoma, and intracranial hemorrhages have been reported in vacuum deliveries.Facial lacerations, facial nerve palsy, and corneal abrasion are more common with forceps delivery.Long-term cognitive outcomes are similar to spontaneous vaginal deliveries [21, 22].Recent data show that the duration of OVD, more specifically vacuum duration, is correlated to a greater risk of adverse neonatal outcomes [23].
Operative delivery
Louise C Kenny, Jenny E Myers in Obstetrics, 2017
The risk of fetal trauma in relation to forceps delivery, particularly rotational procedures, has been long established. There is now a growing recognition that vacuum delivery can also be associated with significant morbidity. In 1998, the USA Food and Drug Administration (FDA) issued a warning about the potential dangers of delivery with the ventouse; this followed several reports of infant fatality secondary to intracranial haemorrhage. In addition, there has been a growing recognition of the short- and long-term morbidity of maternal pelvic floor injury following OVD. It is not surprising, therefore, that there has been an increase in litigation relating to vacuum and forceps delivery. If we are to offer women the option of safe operative deliveries, we need to improve our approach to clinical care. The goal should be to minimize the risk of morbidity and, where morbidity occurs, to minimize the likelihood of litigation, without limiting maternal choice. It is also important to remember that caesarean section, particularly in the second stage of labour, also carries significant morbidity and implications for future births (see Chapter 14, Obstetric emergencies).
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.
Improving labour progression among women with epidural anesthesia following use of a birthing ball: a review of recent literature
Published in Journal of Obstetrics and Gynaecology, 2020
Nicholas Suraci, Christina Carr, Jacquelin Peck, Jason Hoyos, Gerald Rosen
Although, epidural anaesthesia significantly reduces pain during labour, it has also been hypothesised to slow the progression of labour and is associated with increased rates of vacuum and forceps delivery (American College of Obstetricians and Gynecologists Committee on Obstetric Practice 2006). Women who receive epidurals also have decreased ability to ambulate. Increased ambulation results in a shorter first stage of labour compared to women who are left in the recumbent position (Lawrence et al. 2009). This may have important ramifications because the most common clinical indication for caesarean section deliveries is failure to progress during labour (Gifford et al. 2000). Furthermore, caesarian sections have been linked to increased maternal morbidity and mortality. In full term, low-risk pregnancies, planned caesarean sections result in increased risk of severe maternal morbidities compared to planned vaginal deliveries (2.7% versus 0.9%) (Liu et al. 2007). Liu et al. (2007) defined severe maternal morbidities as haemorrhage requiring hysterectomy or transfusion, uterine rupture, anaesthesia complications, shock, cardiac arrest, acute renal failure, assisted ventilation, venous thromboembolism, major infection, or in-hospital wound disruption or haematoma. The true association between epidural anaesthesia and caesarian section requires further evaluation.
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.
Related Knowledge Centers
- Medical Device
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- Caesarean Section
- Cephalic Presentation
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- Glaucoma
- Fetal Distress
- Breech Birth
- Facial Nerve