Parto vaginal operatório / Operative vaginal delivery

PONTOS-CHAVE Quando utilizados na técnica correta, fórcipes e vácuo-extratores apresentam baixos índices de complicações. Para o feto com sinais de hipóxia no período expulsivo, o parto vaginal operatório tem potencial para reduzir a exposição aos fatores intraparto que promovem a encefalopatia hipóxico-isquêmica. Fórcipes médios e/ou rotacionais são opções apropriadas em circunstâncias selecionadas e exigem habilidade e experiência. Os fórcipes são mais resolutivos do que os vácuo-extratores para o parto vaginal operatório, porém são mais associados a lacerações perineais graves. Céfalo-hematoma é mais provável de ocorrer com o aumento na duração da vácuo-extração. Os vácuo-extratores de campânulas flexíveis apresentam taxas maiores de falha, porém apresentam menores incidências de trauma no couro cabeludo do neonato. (AU)

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.

Manometric and ultrasonographic assessment of anal sphincter function following forceps or vacuum assisted vaginal delivery

To compare differences in anal sphincter function following vacuum or forceps assisted vaginal delivery. Prospective, r and omized controlled trial. Al-Azhar University Hospitals in Damietta and Cairo.One hundred and thirty primiparous women were recruited antenatally and if an instrumental delivery was indicated, were r and omized to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow-up consisted of a symptom questionnaire, anal manometry, and endoanal ultrasonography. Faecal continence scores, anal manometry and endoanal ultrasonography. Sixty-one women delivered with forceps assistance [42 for failure to progress in the second stage] and 69 with vacuum assistance [50 for failure to progress]; 16/69 vacuum deliveries proceeded to a forceps assisted delivery [23%]. There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 7 [11%] forceps and 3 [4%] vacuum deliveries. Based on intention-to-treat analysis, 32 [52%] women complained of altered faecal continence after forceps delivery compared with 21 [30%] following vacuum delivery three months postpartum. Endoanal ultrasonography was reported as abnormal following 34 [56%] forceps deliveries and 34 [49%] vacuum deliveries. After exclusion of 'failed vacuum', median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone [p<0.001]. There were no significant differences in degree of ultrasound abnormality between the two groups. Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery

Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity

To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Alia Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction [caput, jaundice, cephalohaematoma]. Serious neonatal morbidity was rare for both groups

Neonatal and maternal complications among pregnant women delivered by vacuum extraction or forceps extraction.

A historical cohort study was used to analyse the maternal and neonatal complications among pregnant women delivered by vacuum or forceps extraction at Rajavithi Hospital, 1994. The maternal complications (third and fourth degree of perineal tear and postpartum hemorrhage) were statistically significant more often in the forceps group than in the vacuum extraction group. But fetal complications (neonatal hyperbilirubinemia, low Apgar scores (< 7) at 1 and 5 minutes and the transfer to NICU) were statistically significant more often in the vacuum extraction group than in the forceps group.

Comparison of vacuum extraction delivery between the conventional metal cup and the new soft rubber cup.

To compare the effectiveness and complications of vacuum extraction delivery between the conventional metal cup and the silicone rubber cup. A prospective randomized clinical trial of 90 pregnant women requiring assisted vaginal delivery who met the predetermined criteria for vacuum extraction were allocated to delivery by the Malstrom metal cup (46 cases) or the silicone rubber cup (44 cases). The two groups were similar in respect of age, parity gestational age and indications for assisted vaginal delivery. The mean and median numbers of tractions and time from cup application to delivery were not significantly different between the groups. The overall success rate was higher in the metal cup (89.1%) than in the rubber cup (79.5%) but not significantly different. The silicone cup was more likely to fail in cases of occiput posterior position, excessive caput, and severe degree of molding. There were no significant differences between groups in terms of Apgar scores, birth canal injury, and maternal blood loss. Scalp injuries occurred more frequently with the metal than with the rubber cup (P = 0.006). Vacuum extraction delivery with the silicone rubber cup is associated with reduced scalp injuries but has a greater tendency to fail when the fetus presents in occiput posterior position, has excessive caput or severe degree of molding.