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.

Vacuum extraction and forceps deliveries; comparison of maternal and neonatal complications

To compare the maternal and neonatal complications after instrumental deliveries. Prospective study. At MH Rawalpindi. Six months from April 15,2006 to October 14,2006. Total 96 instrumental deliveries were carried out; of which 46 were ventouse and 50 were forceps deliveries. 58% of forceps deliveries were carried out in nulliparous and 42% in mulitparous patients as compared to 61% of ventouse deliveries in nulliparous and 39% in multiparous patients. Fetal distress was indication in 68% of forceps deliveries and 61% ventouse deliveries. Prolong second stage [>1 hr] was the second commonest indication i.e., in 18% of forceps deliveries and 13% of ventouse deliveries. Success rate was 90% in ventouse and 97% in forceps deliveries. Extension of episiotomy was more likely to occur with ventouse deliveries and third degree perineal tear occurred more with forceps deliveries. 14 babies were admitted to NICU and 90% of them were due to meconium staining. There was only one intrapartum death in the ventouse delivery group and that was due to intrapartum asphyxia. Forceps are more likely to be used in primigravidas and less likely to fail. Most common indication of instrumental deliveries is fetal distress followed by prolonged second stage. Cephalhaematoma and jaundice are more common in ventouse deliveries. Extension of episiotomy and low apgar score at one minute is more likely to occur with ventouse deliveries where as third degree perineal tear and subconjuctival haemorrhage are more likely to occur in forceps deliveries

Genital fistula--our experience.

Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery.

Depression and anxiety in adulthood as a function of birth trauma in Pakistan

The present study was conducted on [Depression and Anxiety in adulthood as a function of Birth Trauma in Pakistan]. The main aim of the study was to assess the impact of birth trauma and assess the level, of anxiety and depression in adult population of Pakistan. For the purpose of this study Birth Trauma was classified into 2 distinct groups: 500 participants were included in this study. 200 individuals of both sexes born through traumatic brith [including Cesarean Birth and Forceps delivery] 300 Individuals of both sexes were taken as a controlled group who were born through the normal birth procedure. It was hypothesized that individuals born through a traumatic birth procedure will be more vulnerable towards anxiety and depression in adulthood in Pakistan. Following measures were used: Demographic Information Form, IPAT-Anxiety Scale, IPAT- Depression Scale. Chi-Square test was computed in order to obtain the statistical significance of the data. The findings showed that individuals who knew they were born through traumatic birth procedures had high anxiety and depression sten scores on IPAT Anxiety and IPAT Depression scales as compared to individuals born through Normal Birth Procedure

Prognostic relevance of risk factors for obstetrical brachial plexopathy

Realizamos um estudo caso-controle para verificar se o peso ao nascimento, parto forceps ou asfixia perinatal apresentam efeito significativo no prognóstico da plexopatia braquial obstétrica. O grupo A foi composto por 25 lactentes que apresentavam recuperação completa aos 6 meses de idade. O grupo B foi composto por 21 lactentes incapazes de remover uma venda do rosto com o membro acometido na posição sentada aos 12 meses de idade. Não houve diferença significativa entre as medianas de peso ao nascimento ou do boletim Apgar do primeiro minuto entre os grupos. Também não foi observada relação entre peso ao nascimento maior que 4000g, boletim Apgar do primeiro minuto menor do que 6 ou parto forceps com um prognóstico desfavorável.

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

Parto mediante cesárea programada o fórceps medio: ¡Dejemos elegir a la paciente informada! / Elective Cesarean or Midforceps Delivery: Let the Informed Patient Choose!

Healthcare professionals must come to terms with three facts: 1) there is a compelling body of medical evidence implicating vaginal birth with pelvic floor injury which they must acknowledge and incorporate into their practice; 2) the biases inherent in the training of health care professionals colour their advice to patients and their management of the labour and delivery process; 3) women have the right to be involved in a dialogue with their health care professional concerning the relative values placed on the risks and benefits of different modes of delivery and the tools used to achieve them. Elective caesarean delivery is not the best choice for all women but a request for elective caesarean is legitimate and should be respected if a woman is properly informed. Midforceps delivery has a significant detrimental effect on the pelvic floor. Before forceps delivery is undertaken, a woman should be offered the opportunity to decline delivery by that method.

Los profesionales de la salud deben enfrentarse con tres hechos: 1) existe un importante cúmulo de certezas médicas que relacionan el parto vaginal con lesiones del piso pelviano, que los médicos deben reconocer e incorporar a su práctica médica; 2) los sesgos inherentes al entrenamiento de los profesionales médicos imprimen subjetividad al consejo que brindan a sus pacientes, así como a las conductas que toman durante el trabajo de parto y el parto en sí; 3) las mujeres tienen derecho a participar en un diálogo con su médico respecto de los valores relativos asignados a los riesgos y beneficios de los diferentes modos de parto, así como de los instrumentos utilizados para lograrlos. La cesárea programada no es la mejor elección para todas las mujeres, pero es legítimo que una mujer solicite una cesárea programada, y este requerimiento debería ser respetado si la mujer fue apropiadamente informada. El parto realizado mediante fórceps medio conlleva un significativo detrimento para el piso pelviano. Antes de realizar un parto con fórceps, debería ofrecerse a la mujer la oportunidad de rehusarse a dicho procedimiento.

Subgaleal hematoma and seven exchange transfusions.

A 3 kg baby was delivered by cesarean section after prolonged labor. He had massive subgaleal hematoma. He developed anemia requiring packed cell transfusions and hyperbilirubinemia requiring a total of seven exchange transfusions and highly intensive phototherapy. There were no adverse complications of the hyperbilirubinemia or the exchange transfusion.

El individuo indiviso a través de un caso clínico / The indivisible individual through a clinical case

Es la presentación de un caso clínico donde siguiendo nuestra metodología de trabajo basada en un estudio integral del individuo-indiviso, permite al paciente crecer en un óptimo funcional

Uso de forceps terapéuticos con técnica modificada: estudio de 514 casos / Use of therapeutic forceps with modified technique: study of 514 cases

Se estudiaron en el Servicio de Obstetricia y Ginecología del Hospital San Juan de Dios, entre los años 1996, 1997 y 1998, 514 pacientes cuyo parto se verificó mediante fórceps terapéutico. En ese período hubo 17.678 partos con 839 nacimientos con fórceps (4,74 por ciento). De ellos, se seleccionaron 514 con indicación de terminación médica del parto por vía vaginal. En la mayoría de los casos correspondió a sufrimiento fetal, distocia persistente de posición y expulsivo prolongado. Se usó el fórceps de Kielland. Se describe un procedimiento consistente en la aplicación de una rama en el occipucio fetal, traccionando y rotando suavemente durante la contracción uterina con lo que se logra una mayor flexión cefálica, descenso y rotación a una posición anterior para hacer una aplicación biparietomalar baja con traumatismo materno y fetal menos severo que con las maniobras clásicas. Se exponen resultados referentes a la madre y al recién nacido (RN) en los que destaca que el sufrimiento fetal estuvo presente como indicación en 297 pacientes (57,7 por ciento). El Apgar bajo 7 al minuto lo tuvieron 110 RN (21,4 por ciento) y a los 5 minutos sólo lo presentaron 5 (0,97 por ciento). Hubo dos mortineonatos (0,38 por ciento) en los que en uno se diagnosticó una cardiopatía congénita no confirmada y en el otro una retención prolongada de hombros con severa hipoxia. Se presentó un caso de rotura uterina en un útero malformado. Se analizan además resultados concernientes a complicaciones maternas, tales como lesiones cervicales, vaginales, complicaciones del RN y otras

Incontinencia anal en pacientes añosas: su corrección quirúrgica mediante la técnica de parks / Anal incontinence in elderly patients: surgical correction with parks technique

Antecedentes: La incontinencia anal es una patología frecuente en mujeres de edad avanzada. Para su tratamiento quirúrgico, múltiples técnicas se han utilizado con el fin de mejorar la incontinencia esfinteriana. Objetivos: demostrar nuestra experiencia mediante esta técnica, que mejora el ángulo rectoanal, a través de la plicatura del haz puborrectal del elevador del ano. Diseño: Trabajo retrospectivo. Población: Pacientes del sexo femenino con antecedentes de partos por vía vaginal, forcipal en algunos casos. Método: Se presentan ocho casos de incontinencia esfinteriana anal en pacientes añosos tratados durante 1990 y 1999 con la técnica de Parks. Conclusiones: La técnica de Parks, es una alternativa quirúrgica viable y útil para el tratamiento de ésta patología, con la que se logra mejorar temporariamente la continencia con mínimo riesgo y nula morbimortalidad.

Relación entre la incapacidad para la búsqueda y succión del seno y la presencia de trauma perinatal / Relationship between inability for the search and sucking the breast and the presence of perinatal trauma

Dentro de las observaciones hecha en recién nacidos en el Instituto Materno Infantil de Bogotá, se ha encontrado que varios de los niños no realizan el reflejo de búsqueda del seno ni inician la succión, o si lo hacen, es en una forma arrítmica y sin energía. Existen situaciones en las cuales el recién nacido no puede pegarse al seno, privándose así de uno de los mayores placeres de su vida. Tres tipos de factores se relacionan con esta incapacidad: a. Factores relacionados con la madre. b. Factores relacionados con el mismo niño. c. Factores relacionados con el personal de salud y con la misma institución. Entre los factores relacionados con el niño, se pensó que el trauma perinatal, como es el empleo de fórceps y espátulas, podría ser determinante para causar en el niño discapacidad para buscar y succionar. Por la anterior razón, se realizó un estudio de tipo descriptivo en el Instituto Materno Infantil de Bogotá, entre enero y diciembre de 1995, en 331 niños nacidos en la institución y ubicados en los servicios de alojamiento conjunto, cesáreas y cuidados intermedios de pediatría, con el fin de establecer si existe relación entre la presencia de trauma y la incapacidad para búsqueda y succión del seno. Los pacientes pertenecían a familias de bajo nivel sociocultural y eran residentes en áreas aledañas al Instituto. Se practicó examen estomatológico puramente clínico, teniendo en cuenta la integridad de los tejidos bucales y la funcionalidad en relación con la búsqueda, succión-deglución-respiración. Se tomaron como condiciones a examinar, la edad gestacional (38 semanas o más), la integridad de los tejidos bucales, evolución normal del embarazo y la exposición o no a trauma perinatal. Con base en los resultados, se inició la intervención oportuna sobre el niño y se dieron instrucciones a la madre para continuar con la estimulación a fin de alcanzar una feliz lactancia materna

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.

Espátulas de Thierry: aplicación en primíparas con distocia de posición cefálica fetal: experiencia del servicio en 15 años / Thierry's spatulas: application in primiparas with dystocia of fetal cephalic position: service experience through 15 years

Se presentan los resultados obtenidos en una población de 674 primíparas con posición cefálica fetal distócica resueltas instrumentalmente con espátulas de Thierry (ET) 348 pacientes y 326 con fórceps de Kjelland (FK). Se concluye que en aquellas sometidas a resolución con espátulas hay menor morbilidad materno-fetal que las resueltas con ramas de Fórceps, con significación estadística (p< 0,0001). Se recomienda el adiestramiento en su uso por parte de los médicos en formación en la especialidad

Análisis de aplicación de Fórceps Salinas, en el Hospital de Ginecoobstetricia de Garza García, N.L / Analysis of Salinas Forceps application at Hospital de Ginecoobstetricia de Garza García, N.L

Se revisaron 613 casos con complicación de Fórceps Salinas en el Hospital de Ginecoobstetricia de Garza García, N.L. de las Subsecretaría Estatal de Salud, de noviembre de 1992 a abril de 1993. El grupo mayor fue de pacientes con 20 a 29 años de edad (54.5 por ciento), predominaron las primíparas con 55.9 por ciento, el mayor grupo de aplicaciones en productos a término 80.8 por ciento, y el fórceps electivo con 72.5 por ciento, la aplicación baja con 83.0 por ciento, el medio 2.5 por ciento, episiotomía medio lateral derecha en todos los casos, anestesia con bloqueo epidural en 100 por ciento de las pacientese y una sola complicación 0.1 por ciento, la variedad de posición más frecuente fue la OIA con 50 por ciento y la menor la OIP fue de 2.6 por ciento, 96.3 por ciento de los productos con peso mayor de 2,500 g y 87.1 por ciento con apgar de 8-9 al minuto de nacidos. La morbilidad materna fue de 30.1 por ciento, la morbilidad fetal con 6.1 por ciento con un caso de parálisis facial (0.1 por ciento) por fórceps medio, no se presentaron muertes maternas y hubo 3 fetales anteparto, ninguna postparto

Trauma facial perinatal / Birth facial trauma

Se presenta un trabajo de investigación clínica sobre la prevalencia de trauma facial perinatal detectado en el Departamento de Ginecología y Obstetricia del Hospital Central "Dr. Ignacio Morones Prieto" de San Luis Potosí, en un periodo comprendido del 1§ de febrero de 1993 al 31 de enero de 1994. Hubo un total de 4,466 nacimientos vivos, de los cuales 3,166 fueron partos normales, 529 se utilizaron forceps, 771 fueron por cesárea existiendo un total de 22 casos de traumatismo facial. Esto representó un total de 0.49 por ciento de todos los nacimientos. En los que se usaron forceps hubo 14 con trauma facial (2.6 por ciento), en los que se realizó cesárea se presentaron 3 (0.38 por ciento) y de los 3,166 nacimientos normales hubo (0.15 por ciento)