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Richard Johanson - One of the best experts on this subject based on the ideXlab platform.
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vacuum extraction versus Forceps for assisted vaginal Delivery
Cochrane Database of Systematic Reviews, 2010Co-Authors: Richard Johanson, Vijay MenonAbstract:Background Proponents of vacuum Delivery argue that it should be chosen first for assisted vaginal Delivery, because it is less likely to injure the mother. Objectives The objective of this review was to assess the effects of vacuum extraction compared to Forceps, on failure to achieve Delivery and maternal and neonatal morbidity. Search strategy We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: February 1999. Selection criteria Acceptably controlled comparisons of vacuum extraction and Forceps Delivery. Data collection and analysis Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Main results Ten trials were included. The trials were of reasonable quality. Use of the vacuum extractor for assisted vaginal Delivery when compared to Forceps Delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument. Reviewer's conclusions Use of the vacuum extractor rather than Forceps for assisted Delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal haemorrhages seen with Forceps may be a compensatory benefit.
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withdrawn vacuum extraction versus Forceps for assisted vaginal Delivery
Cochrane Database of Systematic Reviews, 2010Co-Authors: Richard JohansonAbstract:BACKGROUND Proponents of vacuum Delivery argue that it should be chosen first for assisted vaginal Delivery, because it is less likely to injure the mother. OBJECTIVES The objective of this review was to assess the effects of vacuum extraction compared to Forceps, on failure to achieve Delivery and maternal and neonatal morbidity. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: February 1999. SELECTION CRITERIA Acceptably controlled comparisons of vacuum extraction and Forceps Delivery. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS Ten trials were included. The trials were of reasonable quality. Use of the vacuum extractor for assisted vaginal Delivery when compared to Forceps Delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument. AUTHORS' CONCLUSIONS Use of the vacuum extractor rather than Forceps for assisted Delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal haemorrhages seen with Forceps may be a compensatory benefit.
Sarah J Stock - One of the best experts on this subject based on the ideXlab platform.
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maternal and neonatal outcomes of successful kielland s rotational Forceps Delivery
Obstetrics & Gynecology, 2013Co-Authors: Sarah J Stock, Katherine Josephs, Sarah Farquharson, Corinne Love, Sarah Cooper, Chris Kissack, Ranjit Akolekar, Jane E Norman, Fiona C DenisonAbstract:OBJECTIVE To estimate the rates of early neonatal and maternal complications in a consecutive series of successful Kielland's rotational Forceps deliveries. METHODS This was a retrospective cohort study of consecutive cases of successful rotational Forceps deliveries performed in singleton pregnancies at 36 weeks of gestation or more in a tertiary referral center in Scotland, UK, from 2001 to 2008 (n=873). We also compared outcomes associated with successful rotational Forceps deliveries in 2008 (n=150) with those of nonrotational Forceps Delivery (n=873), ventouse Delivery (n=159), spontaneous vertex Delivery (n=3,494), and emergency cesarean Delivery (n=947). RESULTS There was one stillbirth associated with a rotational Forceps Delivery. This was diagnosed before application of Forceps. After rotational Forceps deliveries, 58 of 872 (6.7%) of live-born neonates were admitted to the neonatal unit. Twenty-seven of 872 (3.1%) neonates had one or more complications that could be attributable to traumatic Delivery and seven neonates (0.8%) had a diagnosis of neonatal encephalopathy. When compared with alternative methods of Delivery over a single year, neonatal admission rates after Delivery by rotational Forceps deliveries (5 of 150 [3.3%]) were not significantly different from spontaneous vertex Delivery (128 of 3,494 [3.7%; P=1.00]) or ventouse Delivery (6 of 159 [3.8%; P=1.00]) and lower than emergency cesarean Delivery (106 of 947 [11.2%; P=.002). Postpartum hemorrhage rates after rotational Forceps deliveries (8 of 150 [5.3%; P=.008]) were lower than those associated with emergency cesarean Delivery (142 of 947 [15.0%; P=.008]). CONCLUSION Rates of short-term neonatal and maternal complications after successful rotational Forceps deliveries are low. LEVEL OF EVIDENCE II.
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maternal and neonatal outcomes following kielland s rotational Forceps Delivery
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: K S Josephs, Fiona C Denison, Ranjit Akolekar, E S Cooper, Sarah J StockAbstract:Background There has been a decline in the use of Kielland9s rotational Forceps for malpositions, associated with reports that their use results in increased complications. However, most of these studies date from more than 20 years ago, and there is a lack of recent data regarding maternal and neonatal outcomes following Kielland9s rotational Forceps Delivery (KRFD). Aim To describe maternal and neonatal outcomes of KRFD, to compare maternal complications with those of other modes of Delivery, and to examine whether operator experience affects maternal outcome. Methods Retrospective review of KRFD performed in the Simpson Centre for Reproductive Health in Edinburgh between 2001 and 2007 (n=735). Results Overall numbers of neonatal complications were small. There were no perinatal deaths, but 1.8% (13/735) of neonates had a complication that could be attributable to traumatic Delivery (10 nerve palsies, 1 corneal abrasion, 1 fractured clavicle, 1 subarachnoid bleed). 37/735 (5.0%) of women had anal sphincter injury and 6.8% (50/735) postpartum haemorrhage of more than 1000 ml. These complication rates were higher than after spontaneous vaginal Delivery (p>0.05) but not significantly different from rates following other operative vaginal Delivery. Junior registrars had an 8.1% rate of anal sphincter injury in comparison to the consultant rate of 2.1% (p=0.07). Conclusion In contrast to previous studies that found unacceptable rates of neonatal injury, the low incidence here suggests there is still a place for Kielland9s Forceps. In order to draw definitive conclusions about their safety and efficacy long-term outcomes and maternal satisfaction need to be investigated in larger studies.
Fiona C Denison - One of the best experts on this subject based on the ideXlab platform.
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maternal and neonatal outcomes of successful kielland s rotational Forceps Delivery
Obstetrics & Gynecology, 2013Co-Authors: Sarah J Stock, Katherine Josephs, Sarah Farquharson, Corinne Love, Sarah Cooper, Chris Kissack, Ranjit Akolekar, Jane E Norman, Fiona C DenisonAbstract:OBJECTIVE To estimate the rates of early neonatal and maternal complications in a consecutive series of successful Kielland's rotational Forceps deliveries. METHODS This was a retrospective cohort study of consecutive cases of successful rotational Forceps deliveries performed in singleton pregnancies at 36 weeks of gestation or more in a tertiary referral center in Scotland, UK, from 2001 to 2008 (n=873). We also compared outcomes associated with successful rotational Forceps deliveries in 2008 (n=150) with those of nonrotational Forceps Delivery (n=873), ventouse Delivery (n=159), spontaneous vertex Delivery (n=3,494), and emergency cesarean Delivery (n=947). RESULTS There was one stillbirth associated with a rotational Forceps Delivery. This was diagnosed before application of Forceps. After rotational Forceps deliveries, 58 of 872 (6.7%) of live-born neonates were admitted to the neonatal unit. Twenty-seven of 872 (3.1%) neonates had one or more complications that could be attributable to traumatic Delivery and seven neonates (0.8%) had a diagnosis of neonatal encephalopathy. When compared with alternative methods of Delivery over a single year, neonatal admission rates after Delivery by rotational Forceps deliveries (5 of 150 [3.3%]) were not significantly different from spontaneous vertex Delivery (128 of 3,494 [3.7%; P=1.00]) or ventouse Delivery (6 of 159 [3.8%; P=1.00]) and lower than emergency cesarean Delivery (106 of 947 [11.2%; P=.002). Postpartum hemorrhage rates after rotational Forceps deliveries (8 of 150 [5.3%; P=.008]) were lower than those associated with emergency cesarean Delivery (142 of 947 [15.0%; P=.008]). CONCLUSION Rates of short-term neonatal and maternal complications after successful rotational Forceps deliveries are low. LEVEL OF EVIDENCE II.
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maternal and neonatal outcomes following kielland s rotational Forceps Delivery
Archives of Disease in Childhood-fetal and Neonatal Edition, 2010Co-Authors: K S Josephs, Fiona C Denison, Ranjit Akolekar, E S Cooper, Sarah J StockAbstract:Background There has been a decline in the use of Kielland9s rotational Forceps for malpositions, associated with reports that their use results in increased complications. However, most of these studies date from more than 20 years ago, and there is a lack of recent data regarding maternal and neonatal outcomes following Kielland9s rotational Forceps Delivery (KRFD). Aim To describe maternal and neonatal outcomes of KRFD, to compare maternal complications with those of other modes of Delivery, and to examine whether operator experience affects maternal outcome. Methods Retrospective review of KRFD performed in the Simpson Centre for Reproductive Health in Edinburgh between 2001 and 2007 (n=735). Results Overall numbers of neonatal complications were small. There were no perinatal deaths, but 1.8% (13/735) of neonates had a complication that could be attributable to traumatic Delivery (10 nerve palsies, 1 corneal abrasion, 1 fractured clavicle, 1 subarachnoid bleed). 37/735 (5.0%) of women had anal sphincter injury and 6.8% (50/735) postpartum haemorrhage of more than 1000 ml. These complication rates were higher than after spontaneous vaginal Delivery (p>0.05) but not significantly different from rates following other operative vaginal Delivery. Junior registrars had an 8.1% rate of anal sphincter injury in comparison to the consultant rate of 2.1% (p=0.07). Conclusion In contrast to previous studies that found unacceptable rates of neonatal injury, the low incidence here suggests there is still a place for Kielland9s Forceps. In order to draw definitive conclusions about their safety and efficacy long-term outcomes and maternal satisfaction need to be investigated in larger studies.
Deirdre J Murphy - One of the best experts on this subject based on the ideXlab platform.
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Forceps Delivery for non rotational and rotational operative vaginal Delivery
Best Practice & Research in Clinical Obstetrics & Gynaecology, 2019Co-Authors: Mairead Black, Deirdre J MurphyAbstract:Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of Forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted Delivery has a lower failure rate than vacuum-assisted Delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less foetal-neonatal trauma than Forceps-assisted Delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications and contraindications for Forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of Forceps and how to manage an abandoned Forceps-assisted birth. The essential components of informed consent are also discussed.
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qualitative analysis by interviews and video recordings to establish the components of a skilled rotational Forceps Delivery
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013Co-Authors: Rachna Bahl, Deirdre J Murphy, Bryony StrachanAbstract:Abstract Objective To define the skills of a mid-cavity rotational Forceps Delivery to facilitate transfer of skills from expert obstetricians to trainee obstetricians. Study design Qualitative interviews and video analysis carried out at maternity units of two university teaching hospitals (St. Michael's Hospital, Bristol, and Ninewells Hospital, Dundee). Ten obstetricians were identified as experts in conducting operative vaginal deliveries. Semi-structured interviews were carried out to identify key technical skills. The experts were also video recorded conducting mid-cavity rotational deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were individually coded by the three researchers and then compared for consistency of interpretation. The experts reviewed the data for respondent validation. The themes that emerged following the coding were used to formulate a taxonomy of skills. Results Rotational Forceps were preferred by eight experts and two experts preferred manual rotation followed by direct traction Forceps. The final taxonomy included detailed technical skills for Kielland rotational Forceps Delivery and manual rotation followed by direct traction Forceps Delivery. Conclusion This explicitly defined skills taxonomy could aid trainees’ understanding of the technique of rotational Forceps Delivery. This is an important potential contributor to safely reducing the rate of second-stage caesarean section.
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cohort study of Forceps Delivery and the risk of epilepsy in adulthood
American Journal of Obstetrics and Gynecology, 2004Co-Authors: Deirdre J Murphy, Gillian Libby, Patrick F W Chien, Stewart Forsyth, S A Greene, Andrew D MorrisAbstract:Abstract Objective The purpose of this study was to investigate the relationship between Forceps Delivery and epilepsy in adulthood. Study design We conducted a cohort study of 21,441 births with record linkage to data from the Tayside Medicine Monitoring unit (MEMO) and Scottish morbidity records (SMR1). Results Delivery by Forceps was not associated with epilepsy compared with all other deliveries, adjusted odds ratio (OR) 1.0 (95 % CI, 0.6-1.8). Epilepsy in adulthood was associated with a family history of epilepsy, adjusted OR 2.4 (95% CI, 1.7-3.2), increasing social deprivation, adjusted OR 1.1 for each Carstairs score (95% CI, 1.0-1.2), and male gender, adjusted OR 1.4 (95% CI, 1.0-1.8). Preterm birth was associated with an increased risk of epilepsy, adjusted OR 2.0 (95% CI, 1.2-3.2) but no other antenatal, intrapartum, or neonatal risk factors were identified. Conclusion These findings do not suggest an association between Forceps Delivery and epilepsy in adulthood; however, preterm birth may be an important risk factor.
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Forceps Delivery in modern obstetric practice
BMJ, 2004Co-Authors: Roshni R Patel, Deirdre J MurphyAbstract:This review discusses the specific uses and potential advantages of Forceps over other modes of Delivery. To enable women to make an informed choice about mode of Delivery, obstetricians need to be adequately trained and supervised in the use of Forceps Global increases in rates of caesarean section show no sign of abating. The US National Center for Health Statistics reported that deliveries by caesarean section in 2001 had increased to almost a quarter, the highest level since 1989.w1 A similar rate was observed in England, Wales, and Northern Ireland in 2000.1 The greatest increases and variation between institutions are seen among first time mothers with a singleton pregnancy at term and women who have had a previous caesarean section. The American College of Obstetrics and Gynecology has recommended training in instrumental Delivery to control and reduce the rates of caesarean section.w2 In the United States the rates of Forceps Delivery have decreased despite an increase in operative deliveries.w3-w6 In the United Kingdom, the rates of instrumental vaginal Delivery range between 10% and 15%1 w7; these have remained fairly constant, although there has been a change in preference of instrument. In the 1980s most instrumental vaginal deliveries were by Forceps, but by 2000 this had decreased to under a half. Much of the decline has been attributed to an increasing preference for vacuum extraction or for caesarean section when complex vaginal Delivery is anticipated.2 3 w8 Lively discussion in both the medical and the lay press has centred on morbidity associated with operative deliveries, the importance of maternal choice, and best clinical practice.4 w9 w10 Most women still aim for spontaneous vaginal Delivery. If complications do arise during labour it should be possible to offer women suitable alternatives and not solely caesarean …
Vijay Menon - One of the best experts on this subject based on the ideXlab platform.
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vacuum extraction versus Forceps for assisted vaginal Delivery
Cochrane Database of Systematic Reviews, 2010Co-Authors: Richard Johanson, Vijay MenonAbstract:Background Proponents of vacuum Delivery argue that it should be chosen first for assisted vaginal Delivery, because it is less likely to injure the mother. Objectives The objective of this review was to assess the effects of vacuum extraction compared to Forceps, on failure to achieve Delivery and maternal and neonatal morbidity. Search strategy We searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: February 1999. Selection criteria Acceptably controlled comparisons of vacuum extraction and Forceps Delivery. Data collection and analysis Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Main results Ten trials were included. The trials were of reasonable quality. Use of the vacuum extractor for assisted vaginal Delivery when compared to Forceps Delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument. Reviewer's conclusions Use of the vacuum extractor rather than Forceps for assisted Delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal haemorrhages seen with Forceps may be a compensatory benefit.