Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

INTRODUCTION@#There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.@*METHODS@#A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed.@*RESULTS@#A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation.@*CONCLUSION@#The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Application of self-developed rapid tracheotomy apparatus for acute tracheotomy / 中国基层医药

Objective:To investigate the application effects of self-developed rapid tracheotomy apparatus for acute tracheotomy.Methods:A total of 120 patients who underwent an acute tracheotomy in the Weihai Branch of The 970 Hospital of PLA Joint Logistics Support Force from January 2019 to December 2020 were included in this study. These patients were randomly divided into a rapid group and a conventional group, with 60 patients in each group. Patients in the rapid group underwent tracheotomy with a self-developed rapid tracheotomy apparatus. Patients in the conventional group underwent the standard steps of traditional tracheostomy. The operation time, incision length, amount of bleeding, and incidence of postoperative complications were compared between the two groups.Results:The operation time in the rapid group was significantly shorter than that in the conventional group [(4.5 ± 0.9) minutes vs. (19.3 ± 4.7) minutes, t = 23.86, P < 0.001]. The length of incision in the rapid group was significantly shorter than that in the conventional group [(2.8 ± 0.3) cm vs. (4.2 ± 1.3) cm, t = 8.68, P < 0.001]. The amount of bleeding during the surgery in the rapid group was significantly less than that in the conventional group [(4.4 ± 1.6) mL vs. (11.8 ± 4.1) mL, t = 12.99, P < 0.001]. The incidence of postoperative complications in the rapid group was significantly lower than that in the conventional group ( χ2 = 4.66, P = 0.031). Conclusion:The self-developed rapid tracheotomy apparatus for acute tracheotomy can be used to establish an artificial airway quickly and minimally invasively by simplifying the operational steps. It is remarkably innovative to increase safety with open-view operations and decrease the incidence of complications. It can be repeatedly sterilized and reused, which is worthy of clinical application and popularization.

Comparison of teaching effect of hands-on instruction versus video demonstration in forceps delivery for training residents / 中华全科医师杂志

Objective:To evaluate the effectiveness of hands-on training and video demonstration in training of forceps delivery for residents.Methods:Forty nine residents who were rotating in the obstetrics department of Peking Union Medical College Hospital from 2019 to 2021 were enrolled. The residents were randomly divided into two groups: the instructor group ( n=24) was taught by hands-on training of forceps delivery and the video group ( n=25) was instructed by watching video demonstration. All the trainees completed the self-confidence questionnaire survey, and were evaluated by written tests and objective structured assessment of technical skills scoring system. Results:The scores of self-confidence in each item after the simulation training were higher than those before training in both groups; and there were no significant differences between two groups in the increment of scores(mastering knowledge: 1.54±0.98 vs. 1.40±0.71, U=266.68, P=0.480;mastering operation skills: 1.42±0.93 vs.1.80±0.87, U=233.47, P=0.161; mastering forceps structure: 1.63±1.10 vs. 1.88±0.93, U=261.63, P=0.416; confidence in independent operation: 1.13±0.90 vs. 1.00±1.08, U=287.74, P=0.799; evaluation of simulation training: 0.21±0.51 vs. 0.16±0.55, U=288.27, P=0.776). In the written tests, the scores of the instructor group were significantly higher than those of the video group (83.00±7.18 vs.70.56±10.37; t=4.86, P<0.001). In the practical operation, the instructor group significantly outperformed the video group in items of “right blade placement” (0.71±0.46 vs. 0.20±0.41, U=147.54, P<0.001), “objective total score” (6.17±1.46 vs. 4.72±1.65, U=155.49, P=0.003) and “correct traction” (0.85±0.31 vs. 0.56±0.51, U=213.86, P=0.036). Conclusion:Training delivered via hands-on instruction and demonstration was generally more effective than that delivered via video, although both groups show a increased self-confidence in learning and performing forceps delivery.

Validación de un instrumento para evaluar el nivel de conocimiento en la aplicación de fórceps obstétrico / Validation of an instrument to assess the level of knowledge about the application of obstetric forceps

Resumen OBJETIVO: Diseñar y validar un instrumento para evaluar el nivel de conocimiento en la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló con base en el marco teórico; el cuestionario fue objeto de análisis por parte de un grupo de expertos que se basaron en la metodología Delphi. Se obtuvo un constructo de 20 preguntas y se emprendió un estudio para evaluar la pertinencia del instrumento. La confiabilidad se evaluó con el coeficiente de Kuder-Richardson, prueba Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Los datos se procesaron en el programa SPSS versión 21. RESULTADOS: El instrumento se aplicó a 66 médicos residentes con media de edad de 28.5 ± 0.7 años. El coeficiente de Kuder-Richardson fue 0.608. Las pruebas de Kaiser-Meyer-Olkin y Bartlett mostraron que se trató de un instrumento multidimensional. CONCLUSIONES: Se obtuvo un instrumento válido, confiable y multidimensional para determinar el nivel de conocimientos en relación con la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia.

Abstract OBJECTIVE: To design and validate an instrument to assess the level of knowledge of Salinas forceps application in Gynecology and Obstetrics residents. MATERIALS AND METHODS: Descriptive, cross-sectional, validation-type study of an instrument. The first construct was developed based on the theoretical framework; the questionnaire was analyzed by a group of experts based on the Delphi methodology. A construct of 20 questions was obtained and a study was undertaken to assess the relevance of the instrument. Reliability was evaluated with the Kuder-Richardson coefficient, Kaiser-Meyer-Olkin test and Bartlett's sphericity test. The data were processed in SPSS version 21. RESULTS: The instrument was applied to 66 resident physicians with a mean age of 28.5 ± 0.7 years. The Kuder-Richardson coefficient was 0.608. The Kaiser-Meyer-Olkin and Bartlett tests showed that it was a multidimensional instrument. CONCLUSIONS: A valid, reliable and multidimensional instrument was obtained to determine the level of knowledge in relation to the application of Salinas forceps in Gynecology and Obstetrics residents.

Estimación de la frecuencia del parto vaginal instrumentado en Colombia en los años 2015 - 2019. Estudio transversal de registros poblacionales / Estimated frequency of instrumented vaginal delivery in Colombia between 2015 and 2019. Population registry-based cross-sectional study

Objetivos: evaluar la frecuencia del parto instrumentado en Colombia y por regiones entre el 2015 y 2019. Materiales y métodos: estudio de corte transversal a partir de registros poblacionales. Se incluyeron los registros de mujeres con edad gestacional mayor a 28 semanas y parto vaginal. Muestreo consecutivo. La información se obtuvo a partir del certificado de nacido vivo del Departamento Administrativo Nacional de Estadística (DANE). Se realizó la descripción de las variables sociodemográficas y clínicas. La frecuencia del parto instrumentado fue calculada y descrita por año y departamento. Resultados: se incluyeron 3.224.218 registros de recién nacidos vivos. De estos, 1.719.405 (53,33 %) correspondieron a partos vaginales, y 1.468.726 (45,55 %) a partos por vía cesárea. La frecuencia nacional del parto instrumentado entre el 2015 y 2019 fue de 36.087 nacimientos (1,11 %); Antioquia y Bogotá, D.C. fueron los lugares con mayor ocurrencia, 16.201 (4,5 %) y 13.686 (2,52 %), respectivamente. Conclusiones: el parto vaginal instrumentado es la vía de parto con menor ocurrencia en Colombia con tendencia a la disminución. La formación en este recurso para el uso durante el trabajo de parto no debe perderse en la formación del profesional de salud, especialmente en los programas de Ginecología y Obstetricia. Se debe evaluar si el aumento en el adecuado uso de esta técnica puede disminuir la tasa de cesáreas observadas actualmente, así como describir los escenarios clínicos donde su uso es seguro para la madre y el feto. Se requieren estudios prospectivos, pues pueden permitir establecer las causas del descenso en el uso de esta herramienta obstétrica, los resultados maternos y perinatales en términos de su riesgo/beneficio.

Objectives: To assess the frequency of instrumented delivery in Colombia and by regions between 2015 and 2019. Materials and methods: Cross-sectional study based on population registries. Records of women with a gestational age of more than 28 weeks and vaginal delivery were included. Consecutive sampling was used. The information was taken from live birth certificates of the National Administrative Department of Statistics (DANE). Sociodemographic and clinical variables were described. The frequency of instrumented deliveries was calculated and described by year and by department. Results: Overall, 3,224,218 live birth records were included. Of these 1,719,405 (53.33 %) were vaginal deliveries and 1,468,726 (45.55 %) were cesarean births. At a national level, the frequency of instrumented deliveries between 2015 and 2019 was 36,087 births (1.11 %); Antioquia and Bogotá, D.C. were the places with the highest occurrence, with 16,201 (4.5 %) and 13,686 (2.52 %), respectively. Conclusions: The occurrence of instrumented vaginal delivery in Colombia is the lowest and tends to diminish. Training of healthcare professionals in this approach during labor must not be abandoned, particularly in Obstetrics and Gynecology training programs. Further studies should be conducted to determine whether the increased adequate use of this technique could contribute to a lower rate of cesarean sections, and also to describe the clinical setting in which its use is safe for both the mother and the fetus. Prospective studies are required to identify the causes leading to the lower use of this obstetric tool as well as the risks and benefits in terms of maternal and perinatal outcomes.

Training the skills of obstetric forceps delivery for resident doctors by using simulation teaching method / 中华医学教育探索杂志

In this study, 15 second-year resident doctors who had standardized training of OBGYN were taken as research subjects to discuss the effect of training resident doctors with obstetrics forceps by using simulation teaching method. The simulation teaching process includes theoretical study, theoretical examination, simulation teaching of forceps skills and Assessment of forceps skills. In theoretical study section: before learning to use forceps, the students acquired the theoretical knowledge by flipped teaching micro-video mode. In theoretical examination section: the mastery of basic clinical knowledge of using forceps was evaluated through online assessment. In simulation teaching of forceps skills: students who scored 8/10 points were admitted to enter the simulation teaching process, and they had practical training of scenario simulation skills in Clinical Skills Center. In assessment of forceps skills: the mastery of forceps skills was evaluated by standardized forceps delivery procedure items. The results showed that the students in the simulation teaching group had excellent teaching assessment results, and the resident doctors had more confidence in operating forceps independently, and the teaching effect was ideal, which could further promote the simulation teaching of obstetric clinical skills.

Comparative evaluation of efficacy of physics forceps versus conventional forceps in therapeutic extractions of premolars: a prospective clinical study

Background: Dental extraction is the removal of a tooth from the oral cavity and is the most common procedure performed in oral surgery. Conventional exodontia tends to cause unnecessary trauma leading to postoperative pain, loss of tissue and stress for the patient. ‘Atraumatic’ dental extraction techniques have nowadays gained popularity and in such case, physics forceps can be helpful in achieving such results. The aim of the study was to evaluate and compare efficacy of physics forceps versus conventional forceps in therapeutic extraction of premolars.Methods: A total of 35 patients requiring extraction of premolars in maxillary or mandibular arch or both arches for orthodontic treatment purpose were included and divided into groups A and B wherein right sided extractions performed with physics forceps were compared with left sided extractions carried out using conventional forceps in terms of time taken for extraction, bone and soft tissue injury, success score and pain assessment.Results: The present study suggested statistically significant difference between both the groups. Time taken for extraction, trauma to gingival tissue, bone loss, and visual analogue scale (VAS) score was significantly lesser with physics forceps group, when compared to conventional forceps group. Moreover no significant difference in success score was noted between both the groups.Conclusions: Physics forceps are comparatively superior to conventional extraction forceps in terms of lesser time taken for the procedure, lesser tendency to induce trauma to both hard and soft tissue and have been found to induce comparatively lesser pain post extraction.

Análise da percepção de puérperas sobre a assistência ao parto em uma maternidade do Tocantins / Analysis of the perception of puerperal women about maternity care assistance in a maternity of Tocantins

Objetivo: No decorrer dos séculos, o parto migrou do ambiente domiciliar para o hospitalar, sendo então repleto de procedimentos que, embora tenham o intuito de ajudar, nem sempre são adequados ou baseados em evidências. Por isso, o objetivo deste estudo é identificar os procedimentos realizados com parturientes durante o parto em uma maternidade do Tocantins, além de caracterizar o perfil dessas pacientes. Método: Foi aplicado um questionário a 70 puérperas de parto normal, maiores e menores de idade, durante quatro meses. O questionário de referência foi o utilizado do estudo Nascer no Brasil. Resultados: A maioria das pacientes se autodeclarou parda, tinha ao menos o ensino médio completo e era maior de 18 anos. Mais da metade delas tiveram alguma alteração no períneo, 25% sofreram manobra de Kristeller e 88% submeteram-se à litotomia. Além disso, a grande maioria avaliou o serviço da maternidade como bom/ótimo/excelente. Conclusão: A assistência ao parto no Tocantins ainda se divide em práticas adequadas e técnicas ultrapassadas. Trata-se de um estudo original e um dos primeiros nesse sentido realizado no estado mais novo do Brasil.(AU)

Objective: Throughout the centuries, childbirth has migrated from the home environment to the hospital, being then full of procedures that although they are intended to help, are not always adequate or based on evidence. Therefore, the objective of this study is to identify the procedures performed with parturients during childbirth in a maternity hospital in Tocantins, in addition to characterizing the profile of these patients. Method: A questionnaire was applied to 70 mothers of normal birth, older and younger, for four months. The reference questionnaire was used in the Nascer no Brasil study. Results: Most patients declared themselves to be brown, had at least completed high school, and were over 18 years old. More than half of them had some alteration in the perineum, 25% underwent a Kristeller maneuver and 88% underwent lithotomy. In addition, the vast majority rated the maternity service as good/excellent/excellent. Conclusion: Assistance to childbirth in Tocantins is still divided into outdated technical and appropriate practices. This is an original study and one of the first in this sense carried out in the newest state of Brazil.(AU)

Effectiveness of forceps delivery in modern day obstetrics

Background: There has been an alarming rise in number of caesarean sections all over the world. Instrumental delivery plays an important role to reduce this trend globally. Forceps delivery though proper training and expertise can definitely reduce the rising caesarean section rates in the modern-day obstetrics. The aim of this study is to study the effectiveness of forceps delivery in modern obstetrics.Methods: In the present observational study, 20 cases of forceps delivery were studied for maternal and foetal outcomes including postpartum hemorrhage, perineal tears, Apgar score, NICU admissions, birth injury, and mortality.Results: The most common indication for forceps application was maternal exhaustion (80%) followed by foetal distress. All the cases of forceps application in the present study were associated uneventful vaginal delivery. No any adverse maternal outcomes including perineal tears, post-partum hemorrhage was observed in this study. Average birth weight in the present study was 3.2 kgs and Apgar scores at birth and five minutes was within normal limits. No any birth injury was noted in any of the newborns.Conclusions: Forceps delivery is a safe and effective option in modern day obstetrics to reduce the alarming rise in rates of caesarean section globally. Training should be encouraged to develop the expertise of this art of forceps delivery.

Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.

Characteristics of benign and malignant lesions of ampullary polyps and the accuracy of forceps biopsy / 北京大学学报(医学版)

OBJECTIVE@#To distinguish the endoscopic and clinical features of ampullary polyps, to investigate the endoscopic cancer risk factors of ampullary polyps based on the compared differences of benign lesions and adenocarcinoma, and to assess the accuracy of forceps biopsy.@*METHODS@#Authors retrospectively analyzed the data extracted from patients treated with endoscopic papillectomy (EP) from January 2009 to May 2019 in the Department of Gastroenterology, Peking University Third Hospital. Endoscopic pictures and pathology reports were reevaluated and analyzed. Differences between benign and cancer groups were conducted.@*RESULTS@#In the study, 42 cases were involved, 35 to 83 years old, containing 83.3% older than 50 years old patients. The histological types were as follows, 2 for inflammatory polyps (4.8%), 1 for neuroendocrine tumor (2.4%), 1 for hyperplastic polyp (2.4%), 5 for grade Ⅰ adenoma (11.9%), 10 for grade Ⅱ adenoma (23.8%), 4 for grade Ⅲ adenoma (9.5%) and 19 for adenocarcinoma (45.2%), and 90.5% were adenoma or adenocarcinoma. The average age of benign group (inflammatory polyps and adenomas) was (56.7±9.2), which was significantly younger than that of adenocarcinoma group [(66.0±9.8), P=0.004]. Tumor diameter in adenocarcinoma group[(2.3±0.8) cm] was significantly larger than that in benign group[(1.6±0.6) cm, P=0.002]. Benign lesions only showed Yamada type Ⅰ(57.1%)and type Ⅱ(42.9%). The percentage of Yamada type Ⅰ (36.8%)and type Ⅱ(31.6%) in adenocarcinoma group was lower than that in benign group. Moreover, Yamada type Ⅲ (31.5%) was only found in the adenocarcinoma group. Significant differences were observed between the two groups in Yamada types (P=0.046). Most of the benign lesions had clear boundary(18/21, 85.7%). The percentage of clear boundary in adenocarcinoma group (2/19, 10.5%) was significantly lower than that in the benign group (P < 0.001). No significant differences were investigated in color (P=0.353) and surface (P=0.324) between benign and adenocarcinoma lesions. Pooling age, lesion diameter, Yamada type and clear boundary into Logistic regression analysis, only age (OR=1.186, 95%CI 1.025-1.373, P=0.022) and clear boundary (OR=66.218, 95%CI 3.421-1 281.840, P=0.006) were the independent cancer risk factors. Only 2 (10.5%) in the 19 cancer patients had positive biopsy results before EP. As compared with post-EP, 55.3% (21/38) biopsies were under-estimated, including 17 (17/19, 89.5%) adenocarcinomas and 4 (4/10, 40%) grade Ⅱ adenomas.@*CONCLUSION@#adenoma and adenocarcinoma were the major histological type of ampullary po-lyps. Age and unclear boundary were the independent risk factors of ampullary adenocarcinoma. Forceps biopsy was not enough for ampullary polyp differentiation.

Forceps deliveries and fetomaternal outcome in modern obstetrics

Background: In modern obstetrics practice has witnessed an increase in the caesarean section rates everywhere. The incidence of instrumental deliveries varies between 10-12% in UK. The incidence of instrumental deliveries varies between 2.7-5% in India. There is an urgent need to reintroduce instrumental need in the modern obstetrics. Instrumental delivery is one of the basic functions of emergency care according to WHO. This study was done to know the prevalence, indications and fetal outcomes of forceps deliveries.Methods: A retrospective study was conducted at a tertiary teaching hospital, India from January 2014 to December 2018. All cephalic singleton pregnant mothers who underwent forceps delivery after 28 weeks were included. All the forceps delivery done in twins and breech vaginal delivery were excluded. Demographic data, Indication of forceps delivery, maternal complications of forceps delivery like episiotomy extension, cervical tear, vaginal wall tear, PPH and neonatal outcome like low birth weight, NICU admissions, stillbirth, APGAR score at 1 and 5 minutes were recorded. Equal number of mothers of reproductive age group 20-45 ages who underwent normal non breech vaginal deliveries were randomly selected as control.Results: The prevalence of forceps delivery was 5.25%. The most common indication was fetal distress (55%). Most of the mothers were primigravidas in age group 20-30 years (p<0.001). Regarding the neonatal outcome, 72% of the babies were having weight >2.5 kgs.  APGAR <7 at 1 and 5 min was not significant.Conclusions: As fetal distress is the most common indication, every obstetrician should learn the skill of forceps delivery and it should not be a dying art.

Experiencias adquiridas por los residentes de Ginecología y Obstetricia en la instrumentación obstétrica del parto / Experiences acquired by Gynaecology and Obstetrics residents regarding delivery obstetrics instrumentation

Introducción: Los obstetras siempre han tratado de sujetar la cabeza del feto de la manera más segura posible para acelerar el parto y reducir el difícil trabajo de la mujer. La historia del uso de instrumentos obstétricos para facilitar el parto (ya sean fórceps o espátulas) es una parte pintoresca y particular de la historia de la medicina. Objetivos: Identificar la experiencia adquirida por los residentes en la instrumentación obstétrica. Métodos: Para cumplir los objetivos propuestos se revisó el plan temático de la residencia de Ginecobstetricia y posteriormente fueron seleccionados los aspectos referidos al tema en estudio. Resultados: Los resultados encontrados a partir de las encuestas realizadas y los datos aportados por los tutores de formación y la revisión de los libros de partos aportaron el nivel de aprendizaje de los residentes. Conclusiones: Se aprecia en los estudiantes demora en la aprehensión de los conocimientos relacionado con la instrumentación obstétrica(AU)

Introduction: Obstetricians have always tried to hold the fetus head as safely as possible to accelerate delivery and reduce the women's difficult work. The history of usage of obstetric instruments to facilitate labor (whether forceps or spatulas) is a colorful and particular passage in the history of medicine. Objectives: To identify the residents' acquired experience regarding the obstetric instrumentation, for which we decided to determine their received practical theoretical training. Methods: In order to meet the proposed objectives, we reviewed the system of contents for the Gynecology residence and, thereafter, we selected the aspects regarding the subject under study. Results: The results obtained from the surveys conducted and the data provided by the training professors and the review of delivery books contributed to the residents' level of learning. Conclusions: The students show delay in the apprehension of knowledge regarding obstetric instrumentation(AU)

Factores de riesgo asociados con lesión obstétrica del esfínter anal: cohorte retrospectiva / Risk factors associated with obstetric anal sphincter injury: A retrospective cohort

Resumen OBJETIVO: Analizar los factores de riesgo asociados con lesión obstétrica del esfínter anal en una población donde la aplicación de fórceps es bien aceptada. MATERIALES Y MÉTODOS: Estudio de cohorte simple, retrospectivo, al que que se incluyeron pacientes que finalizaron el embarazo por parto, entre enero de 2013 y diciembre de 2017, en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Criterios de inclusión: embarazo mayor de 35 semanas, con feto único y en presentación cefálica. La variable dependiente de lesión obstétrica del esfínter anal se clasificó en tercer y cuarto grado. Para el análisis estadístico se utilizó el programa SPSS Statistics 23; la prueba de χ2 y t de Student para la comparación entre grupos, y razón de momios con intervalo de confianza de 95%. RESULTADOS: Se incluyeron 6199 pacientes. La edad promedio fue de 26.5 años; el peso al nacimiento de 2745 g y se colocaron fórceps en 6.9% (n = 428) casos. La frecuencia de lesión obstétrica del esfínter anal fue de 1.03% (n = 65). Entre los factores de riesgo asociados con lesión del esfínter anal se encontraron: aplicación de fórceps (RM 22.4; IC95% 13.3-36.7, p < 0.001) y primiparidad (RM 2.8; IC95% 1.68-4.93, p < 0.001). CONCLUSIONES: La edad materna de 20 a 30 años, el peso fetal mayor de 3500 g, el parto con fórceps y la primiparidad son factores de riesgo asociados con lesión obstétrica del esfínter anal.

Abstract OBJECTIVE: To analyze the associated risk factors of obstetric anal sphincter injury in a population in which the use of forceps is well accepted. MATERIALS AND METHODS: A simple retrospective cohort was performed where all women with vaginal delivery were identified in a period of 5 years (January 2013 to December 2017). Pregnancies older than 35 weeks were included, unique and in cephalic presentation. The dependent variable of obstetric lesion of the anal sphincter was classified in 3rd and 4th grade. The SPSS 23 program was used for the statistical analysis. χ2 test and Student's t test were used to compare the groups, as well as Odds radio (OR) with a 95% confidence interval (95%CI). RESULTS: A total of 6199 women were included. The average age was 26.5 years, birth weight of 2745 grams on average, forceps were placed in 6.9% (n = 428). The frequency of obstetric lesion of the anal sphincter was 1.03% (n = 65) in the study period. The following risk factors were found to be associated with anal sphincter injury: use of forceps OR 22.4 (95% CI 13.3-36.7, p <0.001), primiparity OR 2.8 (95% CI 1.68-4.93 p < 0.001. CONCLUSIONS: Maternal age of 20 to 30 years, fetal weight greater than 3500 grams, births with forceps and primiparity are risk factors for obstetric anal sphincter injuries.

Clinical analysis of 83 cases of perineal Ⅲ-Ⅳ degree laceration / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the reasons and prevention and treatment measures of acute third-and fourthdegree obstetric lacerations.METHODS: A retrospective analysis of 83 cases of acute third-and fourth-degree obstetric lacerations in the First Affiliated Hospital of Kunming Medical University from 2010 to 2016 was performed.RESULTS:(1)The incidence of 3 rd or 4 th degree laceration was 0.394%(83/21 083),which was 0.433%(72/16 620)in primiparas and 0.246%(11/4463)in multiparous women,there being a statistical difference(P<0.05).(2)The incidence of 3 rd or 4 th degree laceration was significantly increased in the group with episiotomy than without episiotomy[0.583%(48/8229)vs.0.272%(35/12 854),P<0.05].(3)The incidence of 3 rd or 4 th degree laceration was significantly increased in the group with Forceps delivery than without Forceps deliery[3.120%(37/1186)vs.0.231%(46/19 897),P<0.05].(4)In patients with forceps delivery,the incidence of 3 rd or 4 th degree laceration was 2.911%(28/962)in episiotomy group and 4.018%(9/224)in without episiotomy group,there being a significant difference(P<0.05).(5)The incidence of 3 rd or 4 th degree laceration was significantly increased in the macrosomia group than in the non-macrosomia group[1.225%(11/898)vs.0.357%(72/20 185),P<0.05].(6)The incidence of 3 rd or 4 th degree laceration was significantly increased in the prolonged second stage group than in the normal second stage group[2.381%(24/1008)vs.0.294%(59/20 075),P<0.05].CONCLUSION: The incidence of third-and fourth-degree obstetric lacerations is increased in primiparous women,episiotomy,forceps delivery,forceps delivery without episiotomy,big fetal weight and prolonged second stage.

Comparison Of Cervical Biopsy Using Punch Biopsy Forceps Versus Loop Electrode

Context: The biopsy of cervix can be obtained by various methods with availability of newer modalities like loop elec-trode. Objectives: To compare the histo-pathological parameters and clinical outcome of cervical biopsy obtained using punch biopsy forceps versus loop electrode. Methods: Women attending OPD were screened for cervical pa-thology, and colposcopy was done for those who screened positive. Patients who required cervical biopsy after col-poscopy were allocated into 2 group; one undergoing LEEP biopsy and other half biopsied with Punch forceps. During procedure patients were evaluated for the intra–op pain and bleeding and their severity. The histo-pathological di-agnosis was carried out and the sample was studied for its size, adequacy, and presence of any thermal or crush ar-tefacts. Result: The two methods of biopsy were comparable in intra-op parameters, except for the increased re-quirement for additional haemostasis in LEEP biopsy. There was no case of bleeding from biopsy site at the follow-up visit. LEEP biopsy was associated with continued vaginal discharge more often than punch biopsy. An adequate sam-ple for histopathological diagnosis was obtained in 91.25% of all cases. The comparative findings were reflective of comparable efficacy of both methods in providing an acceptable tissue sample for diagnosis. Conclusion: After ana-lysing and comparing the aforementioned parameters, we opined that neither method can be deemed clearly supe-rior to the other as a cervical biopsy procedure.

Un nuevo método sencillo y exacto para medir el tamaño de los pólipos durante la colonoscopia / A simple new method to accurately measure the size of polyps during colonoscopy

Resumen Introducción: tradicionalmente, los pólipos colónicos se miden empíricamente por estimación visual y con las pinzas de biopsia, aunque dichos métodos son inexactos. Diferentes métodos han sido investigados, pero no tienen la exactitud esperada. Por lo anterior, se realizó este trabajo para construir un algoritmo que permitiera medir los pólipos a partir de fotografías tomadas con el colonoscopio. Materiales y métodos: el trabajo se realizó en tres fases. En la primera, se construyó un algoritmo en el programa MATLAB. Se capturaron fotos en formato JPG con el colonoscopio. En la segunda fase, con el algoritmo se midieron imágenes de objetos con tamaños conocidos para verificar la exactitud del algoritmo. Después de verificar la exactitud, fue sometida al algoritmo la fotografía de los pólipos del colon. En la tercera fase, se utilizaron imágenes de pólipos previamente enviadas a tres expertos. Todas las fotografías fueron tomadas con el colonoscopio Olympus Exera II. Resultados: en los objetos menores de 5 mm, el algoritmo sobreestimó el tamaño entre 0,11 y 0,08 mm; en los mayores de 5 mm, sobreestimó el tamaño entre 0,25 mm y 1,76 mm en los de 22 mm. Los expertos sobrestimaron los tamaños de manera importante. En los pólipos de 7, 8 y 9 mm, los expertos dijeron que medían 12, 15 y 18 mm, respectivamente. Conclusión: el algoritmo desarrollado tiene adecuada exactitud para medir pólipos colónicos. Por su fácil consecución y utilización, podría ser una herramienta para solucionar la dificultad de medir pólipos durante una colonoscopia.

Abstract Introduction: Traditionally, colon polyps' measurements have been empirically estimated visually and with biopsy forceps, but neither method is inaccurate. Other methods have been studied but have not had the accuracy expected. The research reported here was undertaken to address this issue by building an algorithm for measure polyps from photographs taken through a colonoscope. Materials and methods: The study was done in three phases. First, an algorithm was built in MATLAB, and photos taken with a colonoscope were stored in the JPG format. In the second phase, images of objects with known sizes were checked against the algorithm to verify its accuracy. After verification of the algorithm's accuracy, photographs of colon polyps were measured using the algorithm. In phase 3, images of polyps previously sent to three experts were measured with the algorithm. All photographs were taken with an Olympus Exera II Colonoscope. Results: For objects smaller than 5 mm, the algorithm overestimated sizes by 0.11 to 0.08 mm. For those greater than 5 mm, it overestimated sizes by 0.25 mm to 1.76 mm in those of 22 mm. The experts seriously overestimated sizes. They estimated that 7 mm polyps measured 12 mm, 8 mm polyps measured 15 mm, and 9 mm polyps measured 18mm. Conclusion: The algorithm developed is sufficiently accurate for measuring colon polyps and is easy to obtain and relatively easy to use. It could become a tool for overcoming the difficulty of measuring polyps during a colonoscopy.

Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.@*METHODS@#Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later.@*RESULTS@#All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation.@*CONCLUSIONS@#The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

Application of intraoperative neuromonitoring during endoscopic thyroidectomy via breast approach / 中华内分泌外科杂志

Objective To explore the technique and significance of intraoperative neuromonitoring (IONM) for scarless in the neck endoscopic thyroidectomy (SET) via breast approach.Methods From Apr.2015 to Oct.2015,101 consecutive patients undergoing SET with IONM were included.During the operation,patients received radical resection of the thyroid cancer by Wang's seven-step method.The lymph nodes in the central area were dissected and Wang's multi-functional separation forceps were implemented for recurrent laryngeal nerve (RLN) positioning,monitoring and protection.Also,time required for RLN positioning and exposure,postoperative transient and permanent RLN damage incidence were calculated to assess the feasibility of IONM under SET.Results Among 101 patients,130 RLNs in total were exposed.The average time required for RLN positioning under IONM was (3.26 ± 1.08)min,with round-nerve management time of (13.95 ± 4.58)min.Nerve signal change happened in 16.9％(22/130) patients.Positive predictive value was 13.6％ and negative predictive value was 100％.The overall accuracy rate was 85.4％.Conclusion IONM during SET is feasible,and can be helpful for the localization and functional protection of RLN and was useful to predict vocal cord paralysis.

Application of Vacuum Extractors and Forceps in Assisted Vaginal Delivery / 中山大学学报(医学科学版)

[Objective] Compare the outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Methods] One hundred and sixty-four pregnant women with operative vaginal delivery who received prenatal examination and delivered in our hospital were enrolled.Eighty-two women with vacuum extractors were assigned into vacuum extractors group,another eighty-two women with low or outlet forceps were assigned into forceps group.Occiput transverse or posterior position women before operative vaginal delivery were assigned into abnormal fetal position group.Compare the maternal and neonatal outcomes of vacuum extractors and forceps in assisted vaginal delivery.[Results] The vaginal laceration rate of forceps group was significant higher than vacuum extractors group (56.1％ vs 24.2％,P ＜ 0.01),but neonatal subscalp hematoma and hyperbilirubinemia rate were lower than vacuum extractors group (P ＜ 0.05).The vaginal laceration rate of abnormal fetal position forceps group was also higher than abnormal fetal position vacuum extractors group (76.5％ vs 22.2％,P ＜ 0.05),but neonatal hyperbilirubinemia rate was lower than abnormal fetal position vacuum extractors group (P ＜ 0.05).The Interval time from decision to delivery,postpartum hemorrhage volume with 24 hours,leukocyte and neutrophil count after 24 hours,asphyxia of newborn rate,intracranial hemorrahge,subgaleal hemorrahge,referral rate and hypoxic-ischemic encephalopathy did not significantly differ between vacuum extractors group and forceps group (all P ＞ 0.05).[Conclusions] Vacuum extractors can reduce the incidence of vaginal laceration rate,especial for abnormal fetal position,but increase the incidence of neonatal subscalp hematoma and hyperbilirubinemia rate.