scholarly journals COMPARISON OF MATERNAL AND NEONATAL OUTCOME IN FORCEPS VERSUS VENTOUSE ASSISTED VAGINAL DELIVERY IN OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF PMCH, PATNA, BIHAR

2021 ◽  
pp. 1-2
Author(s):  
Archana Kumari ◽  
K. Manju ◽  
Debarshi Jana

Objectives: To compare the maternal and neonatal outcome following ventouse and forceps- assisted vaginal deliveries in singleton term pregnancies. Study Design: A cross-sectional study. Duration and Place of study: It was conducted at the Obstetrics and Gynaecology Department of Patna Medical College and Hospital, Patna, Bihar from May 2020 to December 2020. Patients and Methods: All patients who underwent instrumental vaginal delivery during this period, fulfilling the inclusion criteria were studied. Main maternal outcomes were perineal tears while the main neonatal outcomes were Apgar score at 1 minute and at 5 minutes after birth. Neonatal outcome included record of cephalhematoma, shoulder dystocia and need for admission to NICU. In addition to the above, maternal age, gestational age, parity and booking status were also recorded along with the indication for instrumental vaginal delivery for both ventouse and forceps delivery groups. Data was entered into SPSS-15. Percentages were calculated for all the above variables except maternal age and gestational age for which mean + SD were calculated. Chi -square test was used for qualitative variables to assess any difference between the two groups. P-value of equal to or <0.05 considered to be significant. Results: A total of 80 patients underwent ventouse delivery while 120 patients with forceps delivery were included. Mean maternal ages were 25.7+ 4.33 yrs and 25.05+3.47yrs in ventouse and forceps group respectively. 54(67%) and 95(79.16%) were primiparous in ventouse and forceps group respectively. 35(43.7%) were booked cases in ventouse group while this number was 53(44.2%) in forceps group. Fetal distress was the commonest indication of instrument application in 60(75%) and 108(90%) cases in ventouse and forceps group respectively. 16(20%) and 35(29.16%) neonates had Apgar score of <7 at 1 minute in ventouse and forceps group respectively. Apgar score of <7 at 5 minute was observed in 10(12.5%) of ventouse group while 14(11%) of forceps group. 2.5 % (n=2) and 1.66% (n=2) of neonates had shoulder dystocia in ventouse and forceps group respectively. Cephalhematoma was observed in 4(5%) of ventouse group while it was 1.5% (n=2) in forceps group. 11% (n=9) and 10% (n=12) of neonates admitted to NICU in ventouse and forceps group respectively. No case of maternal 3rd degree perineal tear observed in ventouse group while 3(2.5%) of patients had 3rd degree perineal tears in forceps group. Conclusion: Forceps deliveries are more associated with maternal morbidity while neonatal trauma is commoner among those delivered by vacuum extraction however there seems to be no difference in neonatal admission to NICU.

Author(s):  
Budi I Santoso ◽  
Denny Khusen

Objective: To analyze the incidence of anal sphincter ruptures and to evaluate risk factors of obstetric anal sphincter ruptures in Dr. Cipto Mangunkusumo Hospital. Method: We reviewed 2009 vaginal deliveries based on the analysis of obstetric data base and patient records of our department during 2012. Cases and control subjects were chosen randomly and patient’s records were reviewed for the following variable: maternal age, parity, gestational age, labor induction, duration of 2nd stage labor, use of forceps, use of vacuum, use of episiotomy, birth weight, and presentation of the baby. Result: There were 91 (4.53%) anal sphincter ruptures during period of study (91 of 2009 patients). An univariate analysis of these 91 case and 91 randomly selected control subjects show that primiparity (p = .000), gestational age (p = .016), duration of second-stage labor (p = .000), forceps delivery (p = .000), vacuum delivery (p = .001), episiotomy (p = .000), and birth weight (p = .000) increased the risk for anal sphincter ruptures. In multivariate re-gression models, only 5 of the 10 predictor variables were significantly related to the likelihood of having a severe perineal trauma greater than second degree. Primiparity (p = .023; OR 2.74, 95% [CI], 1.15-6.51), forceps delivery (p = .000; OR 18.18, 95% [CI] 3.84-86.07), vacuum delivery (p = .005; OR 6.83, 95% [CI] 1.77-26.42), episiotomy (p = .015; OR 2.86, 95% [CI] 1.23-6.65), and birth weight (p = .000; OR 0.99, 95% [CI] 0.997-0.999). Conclusion: Damage of the anal sphincter resulting in a third- or fourth- degree perineal tear is a relatively rare but severe complication of vaginal delivery. We found that factors as sociated with anal sphincter ruptures were primiparity, forceps, vacuum, episiotomy and birth weight. [Indones J Obstet Gynecol 2016; 1: 31-36] Keywords: anal sphincter ruptures, third- or fourth- degree perineal tear, vaginal delivery


e-CliniC ◽  
2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Irmi Lumempow ◽  
Juneke J. Kaeng ◽  
Max R. Rarung

Abstract: Some factors (as maternal characteristics), which play a role in multiple pregnancies, such as maternal age, parity, and heredity. As for the infant risk factors in multiple deliveries, such as gestational age, birth weight, and APGAR Score. This study provides a description of maternal characteristics and infant risk factors in multiple deliveries in the Prof. Dr. R. D. Kandou Manado Hospital during 2012 to 2013. The results are most of maternal characteristics who performed multiple deliveries in the Prof. Dr. R. D. Kandou Manado Hospital were between 30-34 years of age, second parity, 64% positive in heredity factor, and 73% performed vaginal delivery. The majority of infant risk factors were gestational age in deliveries averaged over 37-40 weeks, with birth weight under 2500 grams and APGAR Score 7-9.Keywords: multiple deliveries, maternal characteristics, infant risk factorAbstrak: Faktor-faktor sebagai karakteristik ibu, yang dapat memicu kehamilan kembar, antara lain faktor usia, jumlah paritas, dan faktor hereditas. Adapun faktor-faktor risiko bayi dalam persalinan kembar, antara lain usia kehamilan sang ibu, berat badan lahir bayi, serta APGAR Score bayi. Penelitian ini memberikan gambaran mengenai karakteristik ibu dan faktor risiko bayi, khususnya dalam persalinan kembar di RSUP Prof Dr. R. D. Kandou Manado periode 1 Januari 2012 sampai dengan 31 Desember 2013. Hasil yang didapatkan adalah kelompok usia ibu terbanyak adalah 30 tahun – 34 tahun, jumlah paritas terbanyak adalah paritas 2, 64% faktor hereditas positif, serta 73% dilakukan persalinan pervaginam. Pada faktor risiko bayi, didapatkan yang terbanyak bayi kembar lahir pada usia kehamilan 37 minggu – 40 minggu, banyak bayi memiliki berat badan lahir di bawah 2500 gram, dan APGAR Score 7 – 9.Kata kunci: persalinan kembar, karakteristik ibu, faktor risiko bayi


2018 ◽  
Vol 13 (3) ◽  
pp. 10-12
Author(s):  
Basant Lamichhane

Aim: To estimate the severity of neonatal and maternal morbidity associated with instrumental vaginal delivery (IVD). Methods: Record based cross-sectional retrospective study of 80 instrumental vaginal deliveries during two years from 2013 to 2015 were performed. Variables studied were neonatal and maternal complications. Results: Out of 80 IVD, 19(23.8%) were forceps deliveries and 61(76.2%) were vacuum deliveries. The mean one minute Apgar score was 6 and 7 for forceps and vacuum delivery respectively. The five minute Apgar score for the both IVD was 8. Regarding maternal complications 7(8.75%) cases had extended episiotomy with deep vaginal tears. In forceps delivery 5 had deep vaginal tear and one each for primary post-partum hemorrhage and urinary retention but among the vacuum deliveries two had deep vaginal tear only. Regarding neonatal complications, one had subgaleal bleed in forceps delivery and one had cephalhematoma with Erbs palsy in vacuum delivery. Conclusions: The neonatal and maternal complications between both types of IVD were comparable. Forceps and repeated vacuum application resulted in low one minute Apgar score; and extended episiotomy and deep vaginal tear were associated with use of forceps.


2021 ◽  
pp. 1-3
Author(s):  
Shweta Pathak ◽  
Manaswita Samanta ◽  
Debarshi Jana

Aim: To study clinical outcomes of immediate postpartum IUCD insertion and to compare immediate postpartum IUCD insertion as a factor of route of insertion (caesarean vs. vaginal). Material and methods: This prospective study was conducted in a Department of Obstetrics and Gynaecology, College of medicine and JNM Hospital, Kalyani, Nadia. Duration of the study was one and half years [ 15 months inclusion, 3 months follow up]. Total 100 cases are included [50 vaginal and 50 caesarean]. Women who were attending or referred to OPD or ER of Dept. of Obst and Gynae, College of medicine and JNM Hospital and delivering either vaginally or by caesarean section, have received counseling for postoperative contraception and have consented to PPIUCD insertion Result:It was found that in Caesarean, 26(52.0%) patients had bleeding P/V 6 weeks. In Vaiginal, 28(56.0%) patients had bleeding P/V 6 weeks. Association of bleeding P/V 6 weeks vs. group was not statistically signicant (p=0.61968). In Caesarean, 11(22.0%) patients had bleeding P/V 3 weeks. In Vaiginal, 13(26.0%) patients had bleeding P/V 3 weeks. Association of bleeding P/V 3 weeks vs. group was not statistically signicant (p=0.6395). Conclusion:Infection was not statistically signicant in two groups at 6 week and 3 month.Missing thread was signicantly higher caesarean delivery compared to vaginal delivery.It was also found that refusal/ continuation was more common in vaginal delivery compared to caesarean delivery, which was not statistically signicant.


2011 ◽  
Vol 25 (1) ◽  
pp. 2
Author(s):  
Leonard Juul ◽  
Gerhard B. Theron

<strong>Objective</strong>. To identify risk factors for thirdand fourth-degree perineal tears, so as to anticipate and intervene in order to prevent this complication that can severely affect a woman’s quality of life. The study design was a retrospective case control study. <strong>Method</strong>. Ninety-three cases of third- and fourth-degree perineal tears were identified from the birth register of a tertiary referral hospital (Tygerberg Hospital). One hundred and nine patients with normal vaginal deliveries in the same time period were used as control group. <strong>Results</strong>. An analysis of the results revealed that there were no significant differences between cases and controls with regards to age, body mass index (BMI), gestation at delivery, duration of second stage, episiotomy and birth weight. However, there were significantly more primigravidas, assisted deliveries (forceps and vacuum), occipitoposterior positions, HIV negative patients and shoulder dystocia in the study group. <strong>Conclusions</strong>. Antenatal risk factors for thirdand fourth-degree tears are difficult to identify. However, intrapartum occipitoposterior and assisted deliveries, especially in the primigravid patient, should warn the obstetrician/ midwife about the risk of a severe tear. A restrictive episiotomy policy should be practiced. Shoulder dystocia was invariably associated with third- and fourth-degree tears in this study. The higher incidence of HIV negative patients in the study group requires further research.


2020 ◽  
Vol 80 (10) ◽  
pp. 1033-1040
Author(s):  
Anne Dathan-Stumpf ◽  
Katharina Winkel ◽  
Holger Stepan

Abstract Objective The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. Material and Methods A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. Results The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Conclusion Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.


2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
A. Cornet ◽  
O. Porta ◽  
L. Piñeiro ◽  
E. Ferriols ◽  
I. Gich ◽  
...  

Background/Aim. To evaluate the obstetrics and gynaecology residents' perspective of their training and experience in the management of perineal tears that occur during assisted vaginal delivery. We hypothesised that residents would perceive room for improvement in their knowledge of pelvic floor anatomy and the training received in tears repair.Design. Descriptive cross-sectional study.Population/Setting. Seventy-two major residents from all teaching hospitals in Catalonia.Methods. A questionnaire was designed to evaluate experience, perception of the training and supervision provided.Results. The questionnaire was sent to all residents (), receiving 46 responses (64%). The participants represented 15 out of the 16 teaching hospitals included in the study (94% of the hospitals represented). Approximately, 52% of residents were in their third year while 48% were in their fourth. The majority of them thought that their knowledge of pelvic floor anatomy was poor (62%), although 98% felt confident that they would know when an episiotomy was correctly indicated. The survey found that they lacked experience in the repair of major degree tears (70% had repaired fewer than ten), and most did not carry out followup procedures.Conclusion. The majority of them indicated that more training in this specific area is necessary (98%).


2017 ◽  
Vol 34 (10) ◽  
pp. 0974-0981 ◽  
Author(s):  
Christina Gonzalez ◽  
Amanda Allshouse ◽  
Erick Henry ◽  
Sean Esplin ◽  
Torri Metz

Objective We aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Study Design Cross-sectional study of candidates for operative vaginal delivery from 18 hospitals over 8 years. Probabilities of mode of delivery were estimated using hierarchical logistic modeling adjusting for clustering within physician and hospital. Results Total 3,771 (64%) women delivered with forceps, 1,474 (25%) vacuums, and 665 (11%) cesareans. Odds of forceps versus vacuum were higher with induction (OR = 2.16, 95% CI: 1.76–2.65), nulliparity (OR = 2.06, 95% CI: 1.59–2.66), epidural (OR = 2.05, 95% CI: 1.19–3.56), maternal indication (OR = 1.53, 95% CI 1.16–2.02), older maternal age (OR 1.18, 95% CI 1.06–1.31 per 5 years), and longer second stage (OR = 1.10, 95% CI: 1.01–1.20 per hour).Odds of cesarean versus operative vaginal delivery were higher with maternal indication (OR = 9.0, 95% CI: 7.23–11.20), a perinatologist (OR = 2.51, 95% CI: 1.09–5.78), longer second stage (OR = 1.79, 95% CI: 1.65–1.93 per hour), older gestational age (OR = 1.10, 95% CI: 1.01–1.20 per week), and longer labor (OR = 1.02, 95% CI: 1.01–1.04 per hour). Conclusion Patient-level factors influence the decision to proceed with an operative vaginal delivery and the choice of instrument, thereby emphasizing the importance of maintaining availability of both forceps and vacuums.


2016 ◽  
Vol 33 (2) ◽  
pp. 65-69
Author(s):  
Jahanara Rahman ◽  
Hosne Ara Begum

Introduction: Non-stress test (NST) is the most common antenatal test performed to assess the foetus at risk of intrauterine hypoxia. On the other hand non-reactivity detected by NST increases the interferences of pregnancy by Caesarean section.Methodology: A cross sectional descriptive study was carried out in the department of Obstetrics and Gynaecology at Dhaka National Medical College between July2007 and June 2008.Objectives: The objectives of the study were (1) To observe the mode of delivery in cases of non-reactive non stress test (NST) and (2) To evaluate perinatal outcome of non-reactive NST.Results: A total 137 high risk pregnant women were included in the study. Age of the women ranges from 16 to 32 years. The mean age of the women was 23.74 ± 3.71 year. Among them 44.53% were primaegravida and 55.47% were multigravida. Gestational age was between 35 and 42 weeks and mean gestational age was 38.34±1.42 weeks. Regarding foetal reactivity 61.3% (n=84) were reactive and 38.7 % (n=53) were non-reactive. Among the babies of non reactive NST 98.11% and 1.89% were delivered by caesarean section and vaginal delivery respectively. Whereas, 48.81% and 51.19% babies of reactive NST were delivered by caesarean section and vaginal delivery respectively. The percentage of caesarean section was much higher in non-reactive NST cases in comparison to that of reactive NST which was statistically highly significant (p value 0.0000). One minute after birth APGAR scoring revealed that 56.6% and 43.4% newborn of non-reactive NST had no depression( APGAR score 7-10) and mild depression ( APGAR score 4-6) respectively. On the other hand 65.47% and 34.5% newborn of reactive NST had no depression and mild depression respectively at one minute after birth. Therefore, small difference was noticed in the neonatal status between the reactive and non-reactive NST which had no statistical significance (p value 0.507). Evaluation of the neonates with APGAR scoring done 5 minutes after birth revealed mild depression (APGAR score 4-6) in 24.53% and 20.24% of non-reactive and reactive NST cases respectively and no depression (APGAR score 7- 10) was found in 75.47% and 70.76% in reactive and nonreactive NST respectively. So, 5 minutes after birth the neonatal status among reactive and non-reactive NST made no significant difference (p value 0.9266).Conclusion: Neonatal evaluation revealed that all foetuses were not compromised as detected by NST. Relying on NST the rate of Caesarean section has been increased. Reassessment of the foetal conditions was needed with the help of other techniques. Therefore NST alone is insufficiently predictive of neonatal outcome.J Bangladesh Coll Phys Surg 2015; 33(2): 65-69


2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Teuku I. Syarwani ◽  
Hermie M. M. Tendean ◽  
John J. E. Wantania

Abstract: Premature rupture of membrane (PROM) is the rupture of the membrane before delivery. This study was aimed to determine the profile of PROM based on maternal age, parity, occupation, duration of PROM, type of delivery, gestational age, and perinatal outcomes. This was a descriptive and retrospective study. Samples were delivery women who had PROM at gestational age≥ 37 weeks and <37 weeks at Prof. Dr. R. D. Kandou Manado form January 1 to December 31, 2018. The results showed a total of 78 patients of PROM. Most patients were 20-34 years (65.39%), senior high school educated (71.80%), housewifery (69.23%), multiparity (58.87%), PROM ≥24 hours (65.38%), gestational age ≥37 weeks (85.90%), cesarean delivery (85.90%), and Apgar score of 7-10 (79.48%). In conclusion, PROM patients in 2018 were more common in age 20-34 years, senior high school educated, housewifery, multiparity, PROM ≥24 hours, gestational age ≥37 weeks, cesarean delivery, and a perinatal outcome of Apgar score of 7-10 (79.48%)Keywords: premature rupture of membrane Abstrak: Ketuban pecah dini (KPD) adalah keadaan pecahnya selaput ketuban sebelum persalinan. Penelitian ini bertujuan untuk mengetahui gambaran kejadian KPD berdasarkan usia ibu, paritas, pekerjaan, lamanya ketuban pecah, jenis persalinan, usia kehamilan, dan luaran perinatal. Jenis penelitian ialah deskriptif retrospektif. Sampelpenelitian ini ialah ibu bersalin yang mengalami KPD pada usia kehamilan ≥37 minggu dan <7 minggu di RSUP Prof. Dr. R. D. Kandou Manado periode 1 Januari -31 Desember 2018. Hasil penelitian mendapatkan total 78 kasus KPD yang terdiri dari ibu berusia 20-34 tahun (65,39%), pendidikan SMA (71,80%), IRT (69,23%), multipara (58,87%), ketuban pecah ≥24 jam (65,38%), usia kehamilan ≥37 minggu (85,90%), persalinan seksio sesarea (85,90%), dan Apgar score 7-10 (79,48%). Simpulan penelitian ini ialah kasus KPD pada tahun 2018 yang paling sering pada usia ibu 20-34 tahun, pendidikan SMA, IRT, multipara, ketuban pecah ≥24 jam, usia kehamilan ≥37 minggu, persalinan seksio sesarea, dan luaran perinatal Apgar score 7-10.Kata kunci: ketuban pecah dini


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