Instrumental deliveries and its outcome in tertiary care center

Background: Objective of the study was to determine the incidence and indication of assisted vaginal deliveries and to compare the fetal and maternal outcome of vacuum and forceps deliveries.Methods: This study done over a period of one and half year from March 2022 to August 2023 at NRI Medical College, Chinnakakani. Total number of vaginal deliveries are 1617, out of which 33 had a successful assisted vaginal delivery and studied in terms of maternal and fetal outcome. Verbal consent was taken, indication for instrumental application documented and pre requisites fulfilled before instrument application.Results: Out of 1617 vaginal deliveries in our institute, 33 cases successful underwent assisted vaginal deliveries in which 49% were vacuum assisted, 51% were forceps assisted deliveries. Most common indication for instrument application were fetal distress (51%), failure of maternal forces followed by maternal exhaustion (30%). We had 2nd degree perineal tear - 2 (11.76%), cervical tear - 1 (5.88%), PPH-1 (5.88%), 1- vaginal laceration (6.25%) as maternal complications. Out of 16 vacuum and 17 forceps deliveries, 5/16 (31.25%) and 8/17 (47.06%) were admitted in NICU respectively.Conclusions: In the present study showed that most common indication for assisted vaginal deliveries are fetal distress and maternal exhaustion. Maternal complications are seen more in forceps deliveries when compared to vaccum. There is no significant difference between vaccum and forceps deliveries in neonatal complications when compared.

Impact of timely obstetric simulation on vaginal breech delivery management

Background: The management of breech presentations represents a significant challenge in obstetrics, necessitating advanced skills for optimal clinical outcomes. Simulation-based training has emerged as a promising approach to enhance the proficiency of healthcare professionals in assisted vaginal breech deliveries, potentially improving neonatal outcomes.Methods: This research study was conducted at Rafic Hariri University Hospital, Beirut, to evaluate the impact of simulation-based training on the management of breech presentations. Using Robson’s classification, a comparative analysis was performed on the outcomes of breech deliveries before and after the implementation of this training. The focus was primarily on assisted vaginal deliveries within the R6 (all nulliparous women with a single breech baby, cesarean section) and R7 (all multiparous women with a single breech baby, cesarean section) groups.Results: Post-training, there was a notable increase in the rate of assisted vaginal deliveries in the R6 category, indicating the effectiveness of the simulation-based training. However, the rate of assisted vaginal deliveries within the R7 group showed no significant change. Additionally, the positive impact of the training demonstrated a time-sensitive decline, underscoring the necessity for ongoing practice and reinforcement of skills.Conclusions: Simulation-based training offers substantial benefits in managing breech presentations, particularly evident in the increased rate of assisted vaginal deliveries among nulliparous women (R6). However, the absence of change in the multiparous women (R7) group and the time-sensitive reduction in training effectiveness highlight the critical need for continuous skill development and reinforcement.

Study of fetomaternal outcome in congenital heart disease in pregnancy in IPGME and R and SSKM Hospital, Kolkata

Background: Because of improving medical and surgical management, most infants born with congenital heart disease (CHD) will reach reproductive age, and women are now presenting for obstetric and congenital cardiac care, many following reparative cardiac surgery or intervention. The maternal and fetal risk of a pregnancy for this population will depend on the anatomic and physiologic classification of the type of CHD. Aim of the study was to determine any complications during pregnancy and after birth in pregnant mother with CHD and to find out any complications of newborn baby, born to a mother with CHD.Methods: The present study was descriptive observational study. This study was conducted for 1 year in department of obstetrics and gynaecology, IPGME and R and SSKMH, Kolkata, sample size 71.Results: In our study there is no maternal death. Most of patients had vaginal delivery under local anesthesia. Thus, concluding early intervention and proper follow up can reduce the morbidity and mortality in CHD mother, vaginal delivery should be preferred in case of CHD in pregnancy. Also, baby born to CHD mother do not suffer from the same disease.Conclusions: We concluded that early intervention and proper antenatal check-up can improve the outcome of the pregnant women with CHD as well as the baby, combined obstetrics and cardiac follow-up can reduced maternal mortality rate. There is no correlation between mother heart diseases with baby.

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.