Advanced technology in obstetric education: a high-fidelity simulator for operative vaginal delivery

2019 ◽  
Vol 47 (9) ◽  
pp. 932-940
Author(s):  
Nicola Perone

Abstract A high-fidelity simulator is described here, specifically designed for vacuum extraction and forceps delivery training. The main purpose behind its development is to remedy the current limited opportunity for training in operative vaginal delivery (OVD), making it easier for young obstetricians to become proficient in this important area of obstetrics. Its introduction into teaching hospitals and academic departments may also help older obstetricians maintain their own competence during periods of inactivity, ensuring patient safety.

1998 ◽  
Vol 63 (2) ◽  
pp. 185-187 ◽  
Author(s):  
E Salamalekis ◽  
N Vitoratos ◽  
C Loghis

2020 ◽  
Vol 69 (2) ◽  
pp. 33-42
Author(s):  
Margarita D. Leonova ◽  
Natalia V. Aganezova ◽  
Sergey S. Aganezov ◽  
Elena V. Frederiks ◽  
Yulia R. Dymarskaya

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods. Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB). Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p 0.05) and III (2.9%, p 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 44.9 ml), when compared to subgroup IA (473 20.7 ml; p 0.05), group II (418 24.9 ml; p 0.05), and group III (347 33.4 ml; p 0.05). There were no differences in blood loss between the outlet OF and VE groups (p 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p 0.01) and in control (5.9%, p 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the childrens hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p 0.05). Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.


2018 ◽  
Vol 5 (3) ◽  
pp. 56-59
Author(s):  
Leonardo de Oliveira Machado ◽  
Mamud Said Neto

RESUMO Introdução A família Chamberlen inventou o fórceps obstétrico nos anos 1600 e, desde então, tem havido várias centenas de versões. Atualmente, os dois tipos mais usados no Reino Unido são Neville Barnes '(NBF) e o fórceps de Wrigley (WF). Metodologia Foi realizada uma pesquisa nas bases Science Direct, Pub Med e Google Scholar para publicações recentes sobre o uso do fórceps utilizando a palavra chave: forceps use. A seleção de estudos potenciais a serem incluídos foi feita revisando os títulos, resumos e data de publicação, sendo selecionados apenas artigos em inglês. Finalmente, foram incluídos para a revisão 21 artigos. Não houve seleção com base na metodologia do estudo, de modo que foram incluídos vários tipos de artigos. Resultados A taxa de partos instrumentais está diminuindo, particularmente o uso de fórceps, que está mais ou menos fora de prática em alguns países europeus como a Romênia. As taxas de parto vaginal instrumental variam amplamente, de 0,5% na Romênia a 16,4% na Irlanda, com um valor mediano de 7,5% na Europa. Conclusão Há mais partos a vácuo sendo realizadas na Europa e em outros países pelos obstetras. No entanto, muitos obstetras preferem usar dispositivos de extração a vácuo do que fórceps, ou realizar cesarianas em vez de partos vaginais operatórios em geral, com medo de litígio, e a crença de que essas são opções mais seguras.   Palavras-chave: fórceps obstétrico, partos instrumentais, uso de fórceps. ABSTRACT Introduction The Chamberlen family invented obstetric forceps in the 1600s, and since then there have been several hundred versions. Currently, the two most commonly used types in the UK are Neville Barnes' (NBF) and Wrigley Forceps (WF). Methodology A search was made at the bases Science Direct, Pub Med and Google Scholar for recent publications on the use of forceps using the keyword: forceps use. The selection of potential studies to be included was done by reviewing the titles, abstracts and date of publication, selecting only articles in English. Finally, 21 articles were included for the review. There was no selection based on the study methodology, so several types of articles were included. Results The rate of instrumental deliveries is declining, particularly the use of forceps, which is more or less out of practice in some European countries such as Romania. Rates of instrumental vaginal delivery vary widely, from 0.5% in Romania to 16.4% in Ireland, with a median value of 7.5% in Europe. Conclusion There are more vacuum deliveries being performed in Europe and in other countries by obstetricians. However, many obstetricians prefer to use vacuum extraction devices than forceps, or perform cesarean deliveries instead of operative vaginal delivery in general, with fear of litigation, and the belief that these are safer options. Keywords: obstetric forceps, instrumental deliveries, forceps use.


Author(s):  
Shilpi Singh ◽  
Munikrishna M. ◽  
Sheela S. R.

Background: Instrumental delivery is an art that is fading and may disappear in the near future as more and more obstetricians are resorting to caesarean sections. Instrumental vaginal deliveries comprise the use of vacuum assisted devices and /or forceps to assist in delivering a fetus, offering the alternative to accomplish vaginal delivery in properly selected cases thereby reducing maternal morbidity in terms of blood loss and increase hospital stay which is a consequence of cesarean sections. The objective of the present study is to compare the maternal morbidity with vacuum and outlet forceps delivery.Methods: A prospective comparative study was conducted in women delivering at department of obstetrics and gynaecology, in SDUMC, R L Jalappa Hospital, Kolar from March 2016 - March 2017 for a period of one year. A minimum of 180 patients were taken up for study. 90 women delivered by outlet forceps delivery and 90 women by vacuum delivery. Cases which require instrumental vaginal delivery and fulfilling the inclusion criteria for forceps or vacuum were taken up for the study, after taking informed consent. Maternal outcomes including episiotomy wound and extension, perineal tear, post-partum hemorrhage, hospital stay was analyzed and compared.Results: Mostly forceps and vacuum were applied for age group of 26-30 years and primigravida, which showed a statistical significance. Extension of episiotomy was more with forceps that is 21.1% and with vacuum being 4.4%. This difference was statistically significant. Postpartum hemorrhage was also more common in forceps group that is 13.3%compared to vacuum 11.1% but the difference was not statistically significant. The need for blood transfusion was seen more in cases of forceps that is 11.1% cases whereas in vacuum i.e. 6.7% cases but was not statistically significant.Conclusions: With the expertise and appropriate decision on the indication and meticulous handling of the instrument whether outlet forceps or vacuum, especially in a tertiary care centre, the maternal outcome is equally good with both the instruments.


2015 ◽  
Vol 15 (1) ◽  
pp. 40-45
Author(s):  
Santa Krievina ◽  
Jelena Dunaiceva ◽  
Anna Miskova

SummaryIntroduction.Epidural analgesia (EA) is widely used as labor analgesia. It has been reported that EA can slow down the course of labor and increase the risk of operative vaginal delivery. Slower course of labor can lead to an increased risk of abnormal fetal heart rate (FHR). Some studies have also demonstrated an increase in occiput posterior position of the fetal head at delivery if EA is used. It represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery.Aim of study. To evaluate the impact of EA on the length of labor and the rate of operative vaginal delivery, and to determine whether EA increases the rate of occiput posterior of the fetal head at deliveryMaterial and methods. We carried out a retrospective case-control study based on clinical records from parturients admitted to Riga Maternity Hospital in 2013. Parturients were divided into two groups: case group comprised parturients who had EA, while parturients of control group did not have EA. Groups were further subdivided into primiparas and multiparas and comparisons were made according to parity. We excluded parturients who had obstructed labor, pathological labor, induction of the labor, history of C-section and significant anomaly of the fetus.Results. A total of 832 parturients were included in the study, 304 in EA group (220 primiparas and 84 multiparas) and 528 in control group (257 primiparas and 271 multiparas). Primiparas of EA group had longer latent phase of the first stage of labor in comparison to primiparas of control group (p=0.001), while multiparas of EA group had longer first stage (p=0.031) of labor and longer latent phase of labor (p<0.001) than their respective controls. Vacuum extraction was used in 1.27% of all deliveries with EA. Moreover, vacuum extraction was used only in primiparas an there was no statistically significant difference between EA group primiparas and control group primiparas (1.7% vs. 1.2%, p=0.593). EA did not increase the rate of occiput posterior positon of fetal head. However, primiparas with EA and occiput posterior were more likely to have an abnormal FHR tracing in comparison to primiparas with EA and without occiput posterior position of fetal head (40% vs. 9.8%, p=0.029; RR=4.09, 95% CI 1.3-12.9). There was no statistically significant link between occiput posterior position and abnormal FHR tracing in control group primiparas.Conclusion. EA does not increase the likelihood of operative vaginal delivery. However, parturients with EA have longer latent phase of the first stage of labor. Risk for occiput posterior at delivery is not increased in labor with EA. However, the risk for abnormal FHR among primiparas who receive EA is increased in case of occiput posterior position of the fetal head.


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