scholarly journals Vacuum Assisted Vaginal Delivery in Singleton Term Pregnancies: Short Term Maternal and Neonatal Outcome in a Tertiary Hospital of Nepal

2016 ◽  
Vol 4 (2) ◽  
pp. 104
Author(s):  
Buddhi Shrestha ◽  
Subha Shrestha ◽  
Babita Thapa
Keyword(s):  
Vaginal Delivery ◽  
Post Partum ◽  
Birth Asphyxia ◽  
College Teaching ◽  
Neonatal Morbidity ◽  
Short Term ◽  
Assisted Vaginal Delivery ◽  
Vaginal Deliveries ◽  
Skilled Operator ◽  
Assisted Delivery

Introduction: Other than cesarean delivery, assisted vaginal delivery is an alternative procedure for delivery in emergency obstetrics. Presently, vacuum delivery has gained more popularity than forceps for operative/ assisted vaginal delivery, when and where indicated, with success as well as lesser neonatal and maternal complications. This study was done to estimate the short term maternal and fetal morbidity/mortality due to vacuum assisted vaginal delivery.   Methods:  A prospective observational study was conducted at Lumbini Medical College Teaching Hospital from January 2015 to May 2016. One hundred and four pregnant women who had successful vacuum assisted vaginal deliveries were enrolled. Fetal and maternal outcome were assessed.   Results: One hundred and four successful vacuum deliveries (2.9%) were conducted among 3457 deliveries during our study period. Sixty seven (64.4%) were primigravida and most (n=59, 56.7%) parturients were of age group 20-30 years. The commonest (n=65, 62.5%) indication for vacuum application was prolonged second stage of labor. The maternal morbidity variables were: 6.7% (n=7) had genital tract injury, 3.8% (n=4) had primary post-partum hemorrhage, 3.8% (n=4) had urinary retention, 2.8% (n=3) needed blood transfusion. Among neonatal morbidity indicators, 19.2% (n=20) neonates had birth asphyxia, 4.8% (n=5) neonates had cephalohematoma, 0.96% (n=1) had brachial plexus injury. There was one early neonatal death due to meconium aspiration syndrome.   Conclusion: A successful vacuum assisted delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labor, skilled operator, and availability of neonatal team.

A STUDY OF FETOMATERNAL OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES AT A RURAL TERTIARY CARE HOSPITAL IN MANDYA DISTRICT KARNATAKA

2021 ◽  
pp. 1-3
Author(s):  
Triza Kumar Lakshman ◽  
Ekta Chhabra ◽  
Ravindra S. Pukale
Keyword(s):  
Vaginal Delivery ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Care Hospital ◽  
Maternal Complications ◽  
Perineal Tear ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries ◽  
Skilled Operator ◽  
Assisted Delivery

Introduction: Giving birth can be a long and painful process and is not always a perfect one. Instrumental vaginal delivery is an art and provides a 1 temporal advantage over cesarean delivery. It is also an alternative procedure for delivery in emergency obstetrics. Instrumental vaginal delivery is an integral part of Obstetrics care world wide. The present study was carried out to evaluate the maternal and neonatal outcome in operative/assisted vaginal delivery. Method: We performed a retrospective observational study of women with singleton term pregnancies who underwent operative vaginal delivery at Adichunchanagiri Institute of Medical Sciences. The study was conducted between August 2019 to August 2020 for the duration of 1 year and the data was accrued from patient database retrospectively and was entered in Microsoft Excel (Version 16.4) for Windows. Results: During the study period, 95 patients underwent Instrumental Vaginal Delivery, of which 74 were vacuum assisted and 21 were forceps nd delivery. The most common indication for Operative vaginal delivery was failure of maternal efforts followed by prolong 2 stage of labour in vacuum group and severe pre-eclampsia in forceps group. Vacuum was used more often than forceps for most of the deliveries. Maternal st nd complication like 1 and 2 degree perineal tear were seen more often with the use of forceps. Instrument marks and bruising were found in the neonates delivered by forceps and a greater incidence of cephalohaematomas and caput in the neonates delivered with vacuum. Conclusion: A successful instrumental vaginal delivery can be achieved with lesser maternal and neonatal morbidity with timely assessment of labour and skilled operator. The overall rate of perinatal and maternal morbidity and mortality vary by indication and operative instrument. Women who underwent forceps-assisted delivery had greater rates of maternal complications than those who underwent vacuum-assisted delivery

scholarly journals Assisted Vaginal Delivery - Preference of Vacuum or Forceps among Obstetricians

2021 ◽  
pp. 147-155
Author(s):  
Vijayalakshmi Gnanasekaran ◽  
Shantha Kanamma ◽  
Shanthi Dhinakaran ◽  
Jikki Kalaiselvi
Keyword(s):  
Vaginal Delivery ◽  
Entire Group ◽  
P Value ◽  
Significant Finding ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Assisted Vaginal Delivery ◽  
Choice Of Procedure ◽  
Vaginal Deliveries ◽  
Assisted Delivery

Objective: To determine the instrument preference among obstetricians practicing operative vaginal deliveries and to determine the prevalence and risks of vacuum or forceps Assisted Vaginal Delivery (AVD). Methods: This cross-sectional study was carried out in ACS Medical and Hospital, Chennai. A total of 520 obstetricians were included in the study. An online questionnaire was sent to all obstetricians in Chennai. The choice of procedure for specific circumstances, instrument preference [use of vacuum or forceps] and views on the complications encountered in both vacuum and forceps use at vaginal delivery were explored. For the replies, we computed means and percentages for the entire group and distinct subgroups. Risk assessment of outcome with exposure as suitable p-value was included in the statistical analysis. Results: Response rate for the questionnaire was 97% (504/520). The findings suggest that obstetricians preference was more towards vacuum due to their ease of usage.   Baseline characteristics were similar between the two groups. Failed vacuum due to slipping of the cup was the most common complication faced - 62%, followed by caput succedaneum 25%, both were statistically significant. The most significant finding was that maternal injuries in the vacuum group were only 2% which was way less than those who had forceps delivery (68%) with a p-value of < 0.001. Conclusion: In this research, physician instrument choice is a significant predictor of results that should be taken into account. Use of vacuum for delivery seemed to be the choice of majority of obstetricians [334 (66%)]. Vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity, whereas neonatal injuries were more common in newborns delivered by vacuum. The choice of instrument should be personalized based on the patient's condition and the obstetrician's experience and expertise.

scholarly journals Vacuum Deliveries: A Retrospective Study on Immediate Maternal and Neonatal Outcomes in Western Regional Hospital, Pokhara

2020 ◽  
Vol 3 (1) ◽  
pp. 234-238
Author(s):  
Deepak Raj Kafle ◽  
Prem Raj Pageni
Keyword(s):  
Retrospective Study ◽  
Vaginal Delivery ◽  
Apgar Score ◽  
Genital Tract ◽  
Neonatal Morbidity ◽  
Regional Hospital ◽  
Assisted Vaginal Delivery ◽  
Second Stage ◽  
Vaginal Deliveries ◽  
Western Regional

Introduction: The overall rate of operative vaginal delivery is diminishing, but the proportion of operative vaginal deliveries conducted by vacuum is increasing. As forceps assisted delivery requires more skill and has more complications on maternal genital tract, this procedure is being less frequently practiced. By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in most of the countries. Vacuum assisted vaginal delivery reduces maternal as well as neonatal morbidity and mortality in prolonged second stage of labor, non reassuring fetal status and maternal conditions requiring a shortened second stage. Materials and Methods: This was a record based retrospective study of 217 vacuum assisted vaginal deliveries conducted at Western Regional Hospital, Pokhara for a period of one year. Patient’s discharge charts were studied and details of indications for vacuum application, maternal genital tract status, amount of blood loss, postpartum hemorrhage (PPH), birth weight, APGAR score at 1 and 5 minute, Neonatal Intensive Care Unit (NICU) admission and neonatal death (NND) were collected. Descriptive data analysis was done using SPSS program. Results: Out of the 8778 deliveries conducted during the study period, 217 (2.47%) cases were vacuum assisted vaginal deliveries. No significant adverse obstetrics outcomes were noted. Most frequent indication was fetal distress which accounted for 53.9%. Though 3rd/4th degree perineal tears were less, episiotomy rate was higher (69.1%). Regarding neonatal outcomes, mean APGAR score at 5 minute was 7.42 ± 1.11 SD and 12.4% neonates had APGAR score of less than 7 at 5 minute. Conclusion: When standard criteria for vacuum application are met and standard norms are followed, there is no evidence of adverse obstetrics outcomes in vacuum assisted vaginal delivery. Prompt delivery by a skilled clinician in non reassuring fetal cardiac status reduces neonatal morbidity and mortality.

scholarly journals Outcome of Assisted Vaginal Deliveries in a Tertiary Care Centre in Bengaluru

2021 ◽  
Vol 10 (40) ◽  
pp. 3538-3542
Author(s):  
Sivasambu Gayatri ◽  
Sujani B. K. ◽  
Urvashi Urvashi ◽  
Priyanka Sinha
Keyword(s):  
Caesarean Section ◽  
Vaginal Delivery ◽  
Caesarean Section Rate ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Tertiary Care Centre ◽  
Mortality And Morbidity ◽  
Assisted Vaginal Delivery ◽  
Safe Delivery ◽  
Vaginal Deliveries

BACKGROUND The lower segment caesarean section (LSCS) audit shows an increase in caesarean section rates worldwide. Assisted vaginal delivery and, if needed, emergency caesarean section are options available to the obstetrician to handle challenges in the second stage when spontaneous and safe delivery is not imminent. Judicious use of the instrument as well as continuing medical education in the art of assisted vaginal delivery is a must to achieve the twin goal of containing the surging caesarean section rate as well as bring about a successful and safe assisted vaginal delivery. The objective of this study was to quantify the various morbidities associated with assisted vaginal deliveries among patients in a tertiary care teaching hospital in Bengaluru. METHODS It is a retrospective study carried for four years between July 2016 and June 2020 at Ramaiah Medical College at Bengaluru. The total number of vaginal deliveries was 6318 out of which 1020 had a successful assisted vaginal delivery and were studied in terms of outcomes, maternal and foetal indications and morbidity. RESULTS Out of 1020 assisted vaginal deliveries, 86.96 % were vacuum-assisted, 3.9 % were forceps assisted and 9.11 % were both vacuum and forceps assisted. The success rate of forceps deliveries was more compared to vacuum. No significant maternal and neonatal mortality and morbidity were observed in our study. CONCLUSIONS In this study, vacuum was the most used method of assisted vaginal delivery and was safer for mothers and babies. It is also easier to teach and learn. Forceps delivery was more used in preterm delivery. KEY WORDS Assisted Vaginal Delivery, Vacuum, Forceps, Sequential use of Instruments, Maternal and Neonatal Morbidity.

scholarly journals Effect of Intrapartum Fever Associated With Epidural Analgesia on Short-Term Maternal and Neonatal Outcomes in Nulliparous Women: A Case Control Study

2020 ◽  
Author(s):  
Huiqian Zeng ◽  
Baohua Lin ◽  
Huizhu Zhang ◽  
Kaimin Guo ◽  
Ping He ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Neonatal Outcomes ◽  
Short Term ◽  
Neonatal Asphyxia ◽  
Nulliparous Women ◽  
Vaginal Deliveries ◽  
Assisted Delivery ◽  
Maternal And Neonatal Outcomes

Abstract BackgroundThe effects of intrapartum fever associated with epidural analgesia in nulliparous women on the short-term maternal and neonatal outcomes are not well understood.Methods We included 2076 nulliparous women who received regular obstetric examination and gave birth at Guangzhou Women and Children’s Medical Center from January 1, 2020 to June 30, 2020. All cases were singleton full-term pregnancies, and all foetuses were in cephalic presentation. We allocated 817 women with temperature >38℃ during labour into the fever group and 1259 women with temperature ≤38℃ during labour to the non-fever group. The short-term maternal and neonatal outcomes in the two groups were compared. Results in the fever group, 8.3% of pregnant women converted to caesarean delivery. The conversion rate in the non-fever group was 5.2% (p = 0.004). The rates of mild neonatal asphyxia, severe neonatal asphyxia, and neonatal hospitalisation in the fever group were higher than those in the non-fever group (χ2 = 12.070, 6.325, and 6.821, respectively, all P<0.05). The 1194 pregnant women in the fever group who had vaginal deliveries spent 756.46 ± 256.43 minutes in the first stage of labour and 65.74 ± 47.63 minutes in the second stage, significantly longer than the 749 women who had vaginal deliveries in the non-fever group (P<0.001, P=0.001). The assisted delivery rate for vaginal delivery in the fever group was 49.0%, significantly higher than that in the non-fever group (2=49.738, P<0.001). The rates of mild neonatal asphyxia, severe neonatal asphyxia, neonatal acidosis, and neonatal hospitalisation with vaginal delivery in the fever group were higher than those in the non-fever group (2=15.375, 6.597, 22.265, and 7.322, respectively, and p<0.001, 0.010, <0.001, and 0.007, respectively).Conclusions Epidural analgesia-associated intrapartum fever in nulliparous women increased the rates of short-term adverse maternal and neonatal outcomes, indicating that efforts are needed to prevent incidence of intrapartum fever due to administration of epidural analgesia.

Risk factors for post-partum hemorrhage following vacuum assisted vaginal delivery

2016 ◽  
Vol 295 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Liran Hiersch ◽  
Riki Bergel-Bson ◽  
Dorit Asher ◽  
Amir Aviram ◽  
Rinat Gabby-Benziv ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Post Partum ◽  
Assisted Vaginal Delivery ◽  
Post Partum Hemorrhage

scholarly journals Risk factors for post-partum hemorrhage in patients who underwent operative vaginal delivery in a tertiary care center

2021 ◽  
Author(s):  
Gayatri Devi Sivasambu ◽  
Sujani B. Kempaiah ◽  
Urvashi Thukral
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Vaginal Delivery ◽  
Post Partum ◽  
Tertiary Care ◽  
Significant Risk ◽  
Post Partum Hemorrhage ◽  
Second Stage ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries

Background: Operative vaginal delivery is a timely intervention to cut short second stage labor when imminent delivery is in the interests of mother, fetus, or both. It reduces second stage cesarean section morbidity and uterine scar and its influence on future obstetric career. The possible structural neonatal adverse outcomes due to operative vaginal delivery are well quantified. However, its effects on maternal outcome need to be understood better. In this paper, we study the effect of operative vaginal delivery on maternal post-partum hemorrhage (PPH) and the associated risk factors.Methods: It was a retrospective study carried out for the period July 2016 to July 2020 at Ramaiah Medical College, Bengaluru. Total number of vaginal deliveries in this period were 6318. Out of these, 1020 patients underwent assisted vaginal delivery using vacuum/ forceps/ sequential use of instrument. Blood loss greater than 500 ml is considered PPH for the purpose of this study. 15% of the study population was noted to have PPH. We employ a multivariate logistic regression to identify statistically significant risk factors for PPH in women undergoing operative vaginal delivery.Results: The logistic regression model identifies multiparity, maternal age, neonatal birth weight more than 3.5 kg, application of forceps in women with hypertensive disorders, III-degree tear, cervical tear to significantly increase the risk of PPH in our study population.Conclusions: Certain factors seem to increase the risk of PPH in operative vaginal delivery. The risks and benefits must be weighed properly before use of instruments.

Resident Operative Vaginal Delivery Volume after Educational Curriculum Implementation

2020 ◽  
Vol 37 (13) ◽  
pp. 1296-1300
Author(s):  
David A. Becker ◽  
Christina T. Blanchard ◽  
Jeff M. Szychowski ◽  
Sharee L. Rogers ◽  
Cynthia G. Brumfield ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Residency Program ◽  
Curriculum Implementation ◽  
The United States ◽  
Assisted Vaginal Delivery ◽  
Regression Curves ◽  
Vaginal Deliveries ◽  
Key Points ◽  
Trends Over Time ◽  
The Impact

Objective The percentage of operative vaginal deliveries (OVDs) in the United States has sharply declined. In May 2016, our institution's obstetrics and gynecology (OB/GYN) residency program implemented a twice-yearly OVD curriculum consisting of didactics and simulation. We sought to evaluate the impact of this curriculum. Study Design We performed a retrospective cohort study of all deliveries at our institution from July 2011 to May 2018. Deliveries were evaluated quarterly for the pre- (July 2011–April 2016) and postcurriculum (July 2016–May 2018) periods. Forceps-assisted vaginal delivery (FAVD), vacuum-assisted vaginal delivery (VAVD), and total OVD percentages, and the ratio of forceps to vacuums were calculated. Pre- and postcurriculum percentages were compared using Wilcoxon's rank-sum test. Cubic regression curves were fit to quarterly percentages to illustrate trends over time. Results The quarterly OVD percentage was unchanged following curriculum implementation (mean 3.2% [Q1–Q3: 2.6–3.5%] pre- vs. 3.1% [2.5–3.8%] post-, p > 0.99). The FAVD percentage was increased (1.2% [0.8–1.5%] vs. 2.0% [1.4–2.6%], p = 0.027) and the VAVD percentage was decreased (2.0% [1.6–2.2%] vs. 1.2% [0.9–1.3%], p < 0.001). This was accompanied by an increase in the ratio of FAVD to VAVD (0.6 [0.4–0.8] vs. 1.7 [1.3–2.2], p < 0.001). FAVD percentage (3.1%) was higher in the last quarter than any other quarter in the 7-year study period, and total OVD percentage (3.9%) was higher in 2018 than any other calendar year. Conclusion The implementation of an OVD curriculum in our OB/GYN residency program resulted in an increase in the percentage of FAVD and the ratio of FAVD to VAVD. Key Points

scholarly journals Fetomaternal outcome in operative vaginal delivery

2021 ◽  
Vol 10 (11) ◽  
pp. 4096
Author(s):  
Jeyamani B. ◽  
Nashreen Dhasleema A.
Keyword(s):  
Vaginal Delivery ◽  
Neonatal Outcome ◽  
Breech Presentation ◽  
P Value ◽  
Perineal Tear ◽  
Cross Sectional ◽  
Second Stage ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries ◽  
Assisted Delivery

Background: Operative vaginal deliveries (OVD) were performed with the help of vacuum or forceps in the second stage of labor when mother and foetus condition is threatening. A successful assisted vaginal delivery avoids caesarean section and its associated morbidity and implications for future pregnancy. The aim of the study was to assess the maternal and neonatal outcome of vacuum and forceps assisted vaginal deliveries.Methods: It was a retrospective comparative cross sectional study done in VMKVMCH, Salem in obstetrics and gynecology department, from the period of April to June 2021. All the mothers delivered by operative vaginal delivery were included. Mothers with multiple pregnancies, preterm and breech presentation were excluded. Data collected using patients information sheet and analysis was done using SPSS 23. P value <0.05 was considered significant.Results: The most common age group was 21-25 years of age in both groups and most commonly used in primigravida. The most common indication for forceps assisted delivery in our study was the prolonged second stage labour and in vacuum delivery was poor maternal effort. In our study, common complication noted was extended episiotomy followed by perineal tear in forceps group and vice versa in vacuum group. Cephalhematoma was found to be more common in vacuum and scalp and instrumental injuries were more common in forceps assisted vaginal deliveries.Conclusions: Operative vaginal deliveries helps in improving both maternal and foetal outcomes and reduces the caesarean delivery rate and vacuum significantly reduces maternal trauma than forceps. No difference noted in neonatal outcome. 

scholarly journals Maternal and neonatal outcomes in vacuum assisted births in the government tertiary care hospital in Mandya: a retrospective record-based study

2020 ◽  
Vol 9 (3) ◽  
pp. 965
Author(s):  
Shwetha M. ◽  
Shilpa M. N.
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neonatal Morbidity ◽  
Vacuum Extraction ◽  
Care Hospital ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Vaginal Deliveries ◽  
Assisted Delivery ◽  
The Government

Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.

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