A comparison of different methods of instrumental delivery based on electronic measurements of compression and traction.

Electronic measurements of compression, using a hydrostatic technique, were made during 44 normal deliveries and compared with the values obtained during 32 deliveries using Kielland's forceps, 21 using Neville Barnes' forceps, 48 using Moolgaoker's adjustable forceps, and 26 using Malmstrom's vacuum extractor. Electronic recordings of traction, using strain gauges, were made simultaneously during all the instrumental deliveries except those with Kielland's forceps. By exercising suitable controls over most of the multiple factors operating at the time of any delivery the authors were able to compare objectively the efficiency of the different methods of instrumental delivery. Smaller forces of compression and traction were exerted and better Apgar scores were recorded in infants delivered with the adjustable forceps than in infants delivered with the other instruments. The superiority of the adjustable forceps was most noticeable during midcavity deliveries of the malrotated head.

Reducing the hospital stay following vaginal hysterectomy.

A rapidly increasing waiting list in a new National Health service district general hospital made it necessary to explore measures to reduce the length of hospital stay of gynecologic inpatients without lowering the standards of medical care. Three years of experience with patients undergoing vaginal hysterectomy after January 1972 is described. During this time, 290 vaginal hysterectomies were performed and combined with pelvic floor repair in 194 cases. The average hospital stay for such patients was 12.7 days in 1971 before this study was commenced; since then this has been reduced progressively to 7.2 days with a corresponding increase in the number of such operations carried out annually. The effects of routine chemoprophylaxis and a modified technic of vault closure are discussed.

The effect of internal urethrotomy and urethral dilatation on the postoperative course of patients undergoing surgery for stress incontinence.

Three years' experience of a total of 128 patients undergoing surgery for stress incontinence is described. Forty-three patients had an internal urethrotomy performed routinely at the end of the operation, 26 had routine urethral dilatation and 59 had neither procedure. Internal urethrotomy, and to a lesser extent urethral dilatation, resulted in prompt return of spontaneous and efficient micturition following removal of the Foley catheter on the third postoperative day. The postoperative stay averaged 6-4 days in the urethrotomy group of patients, 7-6 days in those who had urethral dilatation and 10-6 days in the others. The two-year cure rate in the patients who had neither procedure performed was 85 per cent and as yet no failures have occurred in the patients who had internal urethrotomy or urethral dilatation performed.

Vaginal delivery under caudal analgesia after caesarean section and other major uterine surgery.

In the absence of a recurring indication for caesarean section vaginal delivery in subsequent pregnancy is a "trial of scar," with potentially serious implications for mother and baby. Labour under caudal analgesia was carefully supervised for 75 women with a surgically scarred uterus-due to lower segment section in 72, abdominal hysterotomy in one, and transcavity myomectomy in two. Every caesarean scar was assessed digitally during labour and every uterus was examined after delivery. Caudal analgesia provided a painless labour and delivery and made scar assessment easy. Controlled intravenous Syntocinon infusion was given to 25 patients. One scar dehiscence occurred early in labour and one in the second stage. Seventy mothers had 71 vaginal deliveries with one pair of twins and one breech. There was one stillbirth and no neonatal death. There were five repeat sections.

Legal abortion: a critical assessment of its risks.

A review of the methods used and the results obtained in 1182 legal abortions in one teaching hospital confirms that termination of pregnancy, even in the early weeks, is neither simple nor safe. Nearly 17% of patients lost more than 500 ml. of blood and 9.5% required transfusion. Cervical lacerations occurred in 4.2% and the uterus was perforated in 1.2%. All the perforations were associated with the technique of vacuum aspiration. Emergency laparotomy was required for 6 patients and hysterectomy was twice necessary to save life. Pyrexia of 38 degrees C or more persisting for longer than 24 hours occurred in 27%. Peritonitis developed in 14 patients, with paralytic ileus in 7, and 6 others had septicaemia. No patient died. The need is stressed for a wider appreciation of the risks involved in allowing certain pregnancies to continue and those associated with their termination, irrespective of the method used. Methods of reducing certain of these risks are indicated.