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Comparison of postpartum incontinence outcomes after vacuum-assisted and forceps-assisted deliveries in a tertiary maternity unit. Int Urogynecol J 2021; 33:1529-1537. [PMID: 34383082 DOI: 10.1007/s00192-021-04952-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Forceps-assisted deliveries are an established risk factor for pelvic organ prolapse and pelvic floor injury. However, specific comparison of incontinence outcomes between vacuum-assisted and forceps-assisted deliveries are scarce in the literature. We aimed to compare the initial impact of vacuum and forceps deliveries on new-onset urinary and faecal incontinence as well as pelvic floor muscle strength, with the hypothesis that incontinence outcomes were poorer after forceps- than after vacuum-assisted delivery. METHODS This is a retrospective cohort study of incontinence outcomes in patients who had primary vacuum- or forceps-assisted delivery. The study population included 108 postpartum patients who had undergone operative vaginal delivery (63 vacuum-assisted, 45 forceps-assisted), met the inclusion criteria and attended the postpartum assessment service. Outcomes studied were the presence and severity of symptoms manifesting beyond 1 month postpartum - faecal incontinence and stress, urgency and mixed urinary incontinence - as well as pelvic floor muscle strength scores based on the modified Oxford scale. RESULTS Prevalence of new-onset urinary and faecal incontinence was 35.6% in the forceps group and 30.2% in the vacuum group. The data suggest that there is no significant difference in the prevalence of new-onset incontinence symptoms (p = 0.70, difference in prevalence [forceps - vacuum]: 5.4%, 95% CI -0.25, +0.15), frequency (p = 0.40) and amount (p = 0.48) of urine leakage or mean muscle strength scores (p = 0.89). CONCLUSION In our maternity unit, we observed that type of operative vaginal delivery was not associated with significant differences in urinary incontinence and pelvic floor muscle strength outcomes.
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Dole C, Metz JP, Formet J, Riethmuller D, Ramanah R, Mottet N. Intra pelvic spontaneous rotation of persistent occiput posterior position in case of operative vaginal delivery with spatulas. J Gynecol Obstet Hum Reprod 2020; 50:101943. [PMID: 33069912 DOI: 10.1016/j.jogoh.2020.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In 5 % of vaginal deliveries in case of cephalic presentation there is a persistent occipital posterior position known to be associated with a higher maternal and neonatal morbidity. In these situations, vacuum extractor seems to be the best choice for assisted delivery but it also has limits and contraindications, for example an important caput succadenum or premature birth. The aim of our study was to evaluate the rate of intra-pelvic rotation of persistent occipital posterior position without instrumental rotation in case of operative delivery with spatulas. METHODS This is a retrospective, monocentric and descriptive study evaluating the rate of spontaneous intra-pelvic rotation of persistent occipital posterior position in case of assisted delivery with spatulas among all live births at the Besançon University Medical Center between 2010 and 2017. RESULTS There were 20 205 births during the study and 81(0,4 %) operative deliveries by spatulas in case of persistent occipital posterior position. Delivery in occiput anterior (OA) position was obtained in 36 cases (44.4 %). There was no significant difference in maternal or neonatal morbidity between both groups and perineum injuries were less severe in case of OA delivery. CONCLUSION Operative deliveries by spatulas without instrumental rotation in case of persistent occipital-posterior position seem to be a relevant alternative to vacuum extractor, especially in case of premature birth or important caput succedaneum without altering the maternal or neonatal prognostic.
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Affiliation(s)
- Chloé Dole
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France.
| | - Jean Patrick Metz
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Justine Formet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Didier Riethmuller
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Rajeev Ramanah
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
| | - Nicolas Mottet
- Besançon University Medical Center, Department of Obstetrics and Gynaecology, Alexander Fleming Boulevard, 25000, Besançon, France
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Neonatal subgaleal hemorrhage unrelated to assisted vaginal delivery: clinical course and outcomes. Arch Gynecol Obstet 2019; 301:93-99. [PMID: 31768745 DOI: 10.1007/s00404-019-05392-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the occurrence of subgaleal hemorrhage (SGH) following non-assisted vaginal delivery (normal vaginal delivery or cesarean delivery), and to characterize associated factors, clinical course, and outcomes, compared to attempted assisted vaginal delivery (AVD)-associated SGH METHODS: A retrospective cohort study was conducted. All cases of SGH encountered following delivery of a singleton neonate at Hadassah, Hebrew University Medical Center during 2011-2018 were included. Maternal, fetal, intrapartum, and neonatal characteristics and outcomes were compared between AVD-related and non-AVD-related SGH groups. RESULTS The overall incidence of SGH was 4.5/1000 (369/82,256) singleton deliveries. The incidences of AVD- and non-AVD-related SGH were 44.6/1000 (350/7852) and 0.3/1000 (19/74,404) singleton deliveries, respectively. Ten (53%) of the 19 non-AVD-related SGH were diagnosed after vaginal delivery and 9 (47%) after an urgent cesarean section. SGH severity was mild, moderate, and severe in 68%, 16%, and 16% of the cases, respectively. SGH severity did not differ between the attempted AVD group and the non-AVD-related SGH group. A higher proportion of neonates with non-AVD SGH required phototherapy treatment than did those diagnosed with AVD-related SGH (56% vs. 24%, P = 0.003). Other neonatal outcomes, including Apgar scores, maximal bilirubin level, length of stay, and the rate of composite adverse outcomes, did not differ between the groups. CONCLUSIONS SGH, although rare, may be diagnosed after unassisted vaginal or cesarean delivery in the absence of an AVD attempt. We advocate continuing education for all medical staff who participate in peripartum and neonatal care, regarding the possible occurrence of non-AVD-related SGH.
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Chamagne M, Perdriolle-Galet E, Baumann C, Morel O. [How to proceed after a failed vacuum delivery]. ACTA ACUST UNITED AC 2019; 47:718-725. [PMID: 31121316 DOI: 10.1016/j.gofs.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/02/2016] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Compare maternal and neonatal morbidity in patients delivered by a second instrument versus cesarean section after failed vacuum. METHODS We performed a retrospective study between January 2006 and December 2014. Case notes of 172 failed vacuum deliveries were studied. The studied parameters were blood loss, perineal tears, pH, Apgar score, neonatal reanimation and length of stay in neonatology. RESULTS The frequency of vacuum failure was 8.7%. The use of the second instrument (77.9%) was associated with a higher prevalence of third degree perineal tears (13.4% vs. 0%; P=0.017) and more episiotomy (72.2% vs. 0%; P<0.0001). There was no significant difference regarding post partum hemorrhage between cesarean section and second instrument delivery. There was no significant difference regarding neonatal morbidity between cesarean section and second instrument delivery after failed vacuum. When an attempted second instrument delivery failed, the risk of adverse neonatal outcome was increased: newborns had a significantly longer stay in a neonatal unit (2.4 versus 0.6 days; P=0.026), lower pH (P=0.017), lower Apgar scores (7.4 versus 8.8; P=0.0373), needed intubation (P=0.0471) and had seizures (P=0.04) more often. CONCLUSION Compared to cesarean section, the use of the second instrument increased maternal morbidity but doesn't seem to increase neonatal morbidity. If the second instrument fails, neonatal morbidity is significantly increased.
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Affiliation(s)
- M Chamagne
- Service d'obstétrique, maternité régionale universitaire, 10, rue du Dr Heydenreich, 54000 Nancy, France.
| | - E Perdriolle-Galet
- Service d'obstétrique, maternité régionale universitaire, 10, rue du Dr Heydenreich, 54000 Nancy, France; Unité Inserm U947, laboratoire IADI, université de Lorraine, 54500 Vandoeuvre-les-Nancy, France
| | - C Baumann
- Unité ESPRI-Biobase Plateforme d'aide a la recherche clinique (PARC), CHRU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - O Morel
- Service d'obstétrique, maternité régionale universitaire, 10, rue du Dr Heydenreich, 54000 Nancy, France; Unité Inserm U947, laboratoire IADI, université de Lorraine, 54500 Vandoeuvre-les-Nancy, France; France PremUp Foundation, 75000 Paris, France
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5
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[Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention]. ACTA ACUST UNITED AC 2018; 46:419-426. [PMID: 29500142 DOI: 10.1016/j.gofs.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 12/11/2022]
Abstract
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
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Ginod P, Khallouk B, Benzenine E, Desplanches T, Dub T, Schmutz E, Douvier S, Sagot P. [Assessment of restrictive episiotomy use and impact on perineal tears in the Burgundy's Perinatal Network]. ACTA ACUST UNITED AC 2016; 45:1165-1171. [PMID: 27720515 DOI: 10.1016/j.jgyn.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 07/10/2016] [Accepted: 08/30/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse episiotomy and perineal tears rates in Burgundy after French National College of Obstetricians and Gynecologists (CNGOF) guidelines in 2005. MATERIALS AND METHOD Multicenter retrospective study, between 2003-2005 (period 1) et 2012-2014 (period 2), conducted on singletons vaginal deliveries, in cephalic presentation from 37 weeks. We compared the episiotomy rate (ER), and perineal lesions in normal deliveries (ND) and instrumental deliveries (ID) between the two periods. RESULTS A total of 74,268 women were included. The overall ER significantly decreased from 35.8 to 16.7% (P<0.01), without increasing third degree perineal tears (0.73% vs. 0.66%) or fourth degree (0.14% vs 0.14%). First degree perineal tears rose (42.1% vs 17.6%, P<0.001), second degree decreased (13.5% vs 20.5%, P<0.001). ER decreased whatever the level of motherhood, healthcare ward, vaginal delivery type, or the instrument used. CONCLUSION Our study found a strong impact in Burgundy of the French guidelines for the practice of restrictive episiotomy for both ND and for ID without increasing sphincter tears and in decreasing spontaneous morbidity.
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Affiliation(s)
- P Ginod
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France.
| | - B Khallouk
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - E Benzenine
- Réseau périnatal de Bourgogne, 4, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - T Desplanches
- Réseau périnatal de Bourgogne, 4, boulevard Maréchal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - T Dub
- Hotel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du Parvis-de-Notre-Dame, 75004 Paris, France
| | - E Schmutz
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - S Douvier
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
| | - P Sagot
- Service de gynécologie-obstétrique, CHU F.-Mitterand, 14, rue Gaffarel, 21000 Dijon, France
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Garcia-Mejido JA, Gutierrez L, Fernandez-Palacín A, Aquise A, Sainz JA. Levator ani muscle injuries associated with vaginal vacuum assisted delivery determined by 3/4D transperineal ultrasound. J Matern Fetal Neonatal Med 2016; 30:1891-1896. [DOI: 10.1080/14767058.2016.1228104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J. A. Garcia-Mejido
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain,
| | - L. Gutierrez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain,
| | - A. Fernandez-Palacín
- Biostatistics Unit, Department of Preventive Medicine and Public Health, University of Seville, Seville, Spain, and
| | - A. Aquise
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain,
| | - J. A. Sainz
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain,
- Department of Obstetrics and Gynecology, University of Seville, Seville, Spain
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Equy V, David-Tchouda S, Dreyfus M, Riethmuller D, Vendittelli F, Cabaud V, Langer B, Margier J, Bosson JL, Schaal JP. Clinical impact of the disposable ventouse iCup® versus a metallic vacuum cup: a multicenter randomized controlled trial. BMC Pregnancy Childbirth 2015; 15:332. [PMID: 26666981 PMCID: PMC4678725 DOI: 10.1186/s12884-015-0771-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 12/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Assisted vaginal delivery by vacuum extraction is frequent. Metallic resterilizible metallic vacuum cups have been routinely used in France. In the last few years a new disposable semi-soft vacuum extraction cup, the iCup, has been introduced. Our objective was to compare maternal and new-born outcomes between this disposable cup and the commonly used Drapier-Faure metallic cup. Methods This was a multicenter prospective randomized controlled open clinical trial performed in the maternity units of five university hospitals and one community hospital in France from October 2009 to February 2013. We included consecutive eligible women with a singleton gestation of at least 37 weeks who required vacuum assisted delivery. Women were randomized to vacuum extraction using the iCup or usual Drapier-Faure metallic cup. The primary outcome was a composite criterion including both the risk of cup dysfunction and the most frequent maternal and neonatal harms: the use of other instruments after attempted vacuum extraction, caesarean section after attempted vacuum extraction, three detachments of the cup, caput succedaneum, cephalohaematoma, episiotomy and perineal tears. Results 335 women were randomized to the disposable cup and 333 to extraction using the metallic cup. There was no significant difference between the two groups for the primary outcome. However, failed instrumental delivery was more frequent in the disposable cup group, mainly due to detachment: 35.6 % vs 7.1 %, p < 0.0001. Conversely, perineal tears were more frequent in the metallic cup group, especially third or fourth grade perineal tears: 1.7 % versus 5.0 %, p = 0.003. There were no significant differences between the two groups concerning post-partum haemorrhage, transfer to a neonatal intensive care unit (NICU) or serious adverse events. Conclusions While the disposable cup had more detachments and extraction failures than the standard metallic cup, this innovative disposable device had the advantage of fewer perineal injuries. Trial registration www.clinicaltrials.gov: NCT01058200 on Jan. 27 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0771-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Véronique Equy
- Obstetrical Care Unit, 'Hôpital Couple Enfant', Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France.
| | - Sandra David-Tchouda
- Grenoble University Hospital, Clinical and Medico-economic Evaluation Unit - Clinical Research and Innovation Department, Grenoble University Hospital, 38000, Grenoble, France. .,TIMC-Imag UMR 5525, Université Grenoble Alpes, 38000, Grenoble, France.
| | - Michel Dreyfus
- Obstetrical Care Unit, 'Hôpital Femme Enfant', Caen University Hospital, 14033, Caen, France.
| | - Didier Riethmuller
- Obstetrical Care Unit, 'Pôle Mère-Femme', Besançon University Hospital, 25030, Besançon, France.
| | - Françoise Vendittelli
- Obstetrical Care Unit, Site Estaing, Clermont-Ferrand University Hospital, 1 place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex 1, France. .,Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont University, Université d'Auvergne, 63001, Clermont-Ferrand, France.
| | - Victoire Cabaud
- Obstetrical Care Unit, Chambéry Hospital, 73011, Chambéry, France.
| | - Bruno Langer
- Obstetrical Care Unit, 'Hôpital Hautepierre', Strasbourg University Hospital, 67098, Strasbourg, France.
| | - Jennifer Margier
- Grenoble University Hospital, Clinical and Medico-economic Evaluation Unit - Clinical Research and Innovation Department, Grenoble University Hospital, 38000, Grenoble, France.
| | - Jean-Luc Bosson
- TIMC-Imag UMR 5525, Université Grenoble Alpes, 38000, Grenoble, France. .,INSERM CIC 1406, Grenoble University Hospital, 38000, Grenoble, France.
| | - Jean-Patrick Schaal
- Obstetrical Care Unit, 'Hôpital Couple Enfant', Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France
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Dupuis O, Meysonnier C, Clerc J. [Forceps delivery: Professionals' knowledge of forceps application in the area of Lyon]. ACTA ACUST UNITED AC 2015; 45:343-52. [PMID: 26096348 DOI: 10.1016/j.jgyn.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/30/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study is to describe knowledge on forceps delivery in the area of Lyon. MATERIAL AND METHODS It is a multicentric observational study carried between January 1, 2013 and June 9, 2013. A questionnaire was sent to obstetricians and residents of the area of Lyon. It related prerequisites for operative vaginal delivery, the method used to apply forceps, practices and preferences of operators. RESULTS Seventy-five responses were obtained (47 obstetricians, 28 residents). About prerequisites: 6.4% of the obstetricians and 14.3% of the residents never do urinary catheterization. Instrumental delivery is never performed when the fetal head is not engaged. Mid-pelvic operative vaginal delivery is performed by 51.1% of obstetricians. Trans-abdominal ultrasound assessment is conducted in cases of clinical doubts about the fetal head position. For occipital anterior and left anterior positions, the left blade is first applied. A flexion of the fetal head is applied for anterior positions but not in posterior positions. Most of operators do not perform instrumental rotation. Vacuum extractor is the privileged instrument for obstetricians and forceps is often used in second line. CONCLUSION This study shows that most of the recommendations for forceps delivery are followed. In front of the lake of statistical power of this study, it might be interesting to improve a largest study with a comparison between obstetricians and residents' practices.
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Affiliation(s)
- O Dupuis
- Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France
| | - C Meysonnier
- Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France.
| | - J Clerc
- Département d'obstétrique et de gynécologie, centre hospitalier Lyon Sud, 69310 Pierre-Bénite, France
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Chung MY, Wan OYK, Cheung RYK, Chung TKH, Chan SSC. Prevalence of levator ani muscle injury and health-related quality of life in primiparous Chinese women after instrumental delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:728-733. [PMID: 25331305 DOI: 10.1002/uog.14700] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/04/2014] [Accepted: 10/10/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Levator ani muscle (LAM) injury is common after first vaginal delivery, and a higher incidence is associated with instrumental delivery. This study was conducted to compare the incidence of LAM injury after forceps or ventouse extraction in primiparous Chinese women, and to study their subsequent health-related quality of life. METHODS This prospective observational study was conducted between 1 September 2011 and 31 May 2012 in a tertiary obstetric unit. All eligible primiparous women who had undergone instrumental delivery were recruited 1 to 3 days following delivery. The subjects completed the Pelvic Floor Distress Inventory questionnaire and Pelvic Floor Impact Questionnaire, and translabial ultrasound was performed 8 weeks' postpartum to determine whether the subjects had suffered LAM injury. RESULTS Among the 289 women who completed the study, 247 (85.5%) had ventouse extraction and 42 (14.5%) had forceps delivery. Subsequent translabial ultrasound identified a total of 58 women with LAM injury. The prevalence of LAM injury after ventouse extraction and forceps delivery was 16.6% (95% CI, 12.0-21.2%) (41/247) and 40.5% (95% CI, 25.6-55.4%) (17/42), respectively (P = 0.001). Forceps delivery was identified as a risk factor for LAM injury, with an odds ratio of 3.54. No statistically significant differences were observed between the quality of life in women who underwent ventouse extraction and those with forceps delivery or between the quality of life in women with a unilateral or bilateral LAM injury. CONCLUSIONS In our cohort of primiparous Chinese women, 20.1% (58/289) had LAM injury after instrumental delivery, and forceps delivery was identified as the only risk factor.
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Affiliation(s)
- M Y Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
| | - O Y K Wan
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
| | - R Y K Cheung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
| | - T K H Chung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
| | - S S C Chan
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR
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Perrotin F, Simon E, Potin J, Laffon M. Modalités de naissance du fœtus porteur d’un RCIU. ACTA ACUST UNITED AC 2013; 42:975-84. [DOI: 10.1016/j.jgyn.2013.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Le Brun C, Beucher G, Morello R, Jones F, Lamendour N, Dreyfus M. [Failure of vacuum extractions: risk factors, maternal and fetal issues]. ACTA ACUST UNITED AC 2013; 42:693-702. [PMID: 23702434 DOI: 10.1016/j.jgyn.2013.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 03/28/2013] [Accepted: 04/11/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Determine cases which are at risk of vacuum extraction failure as well as maternal and foetal issues depending on the delivery outcome. MATERIAL AND METHODS It was a retrospective study comparing 147 vacuum failures, from January 2002 to December 2010, with a control group randomly composed of 526 successful vacuum extractions. The outcomes were high risk situations of vacuum failure, maternal and neonatal morbidity depending on the delivery method (caesarean section or other instrumental extraction). RESULTS The global vacuum failure rate was 3.3 %. During labour, we identified several situations at risk of vacuum extraction failure: cephalhematomas prior to extraction (P<0.001), deflexion attitude (P<0.001), posterior variety (P<0.001), entering above the inlet strait (P<0.001), occiput posterior delivery (P<0.001), fœtal weight greater than 3500g (P=0.023). Neonatals consequency were more Apgar score below 7 at five minutes life (P=0.007), fœtal acidosis (pH<7,20) (P=0.032), neonatal resuscitation (P<0.001), and craniofacial damages (P<0.001). CONCLUSION Many dystocic situations occurring during labour require intense care when practicing vacuum extraction since they more frequently result in failure. In case of vacuum extraction failure, immediate adaptation to extra-uterine life seems to be more difficult for new-born babies.
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Affiliation(s)
- C Le Brun
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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Nonaccidental head injury. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/b978-0-444-52910-7.00012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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14
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Chan SSC, Cheung RYK, Yiu AKW, Lee LLL, Pang AWL, Choy KW, Leung TY, Chung TKH. Prevalence of levator ani muscle injury in Chinese women after first delivery. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:704-709. [PMID: 22045587 DOI: 10.1002/uog.10132] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess the prevalence of levator ani muscle injury in Chinese women after their first delivery and investigate associated factors. METHODS A prospective observational study was conducted involving Chinese nulliparous women recruited in the first trimester of pregnancy. Translabial ultrasound was performed at 35-38 weeks' gestation and 8 weeks postpartum and three-dimensional volume datasets were obtained. Offline analysis to detect levator ani muscle injury was performed by investigators blinded to the delivery details. RESULTS 339 women, with a mean age of 30.6 ± 3.9 years, completed the study. Overall, 201 (59.3%) had a spontaneous vaginal delivery, 62 (18.3%) an operative vaginal delivery (48 ventouse extraction and 14 forceps delivery), 14 (4.1%) an elective Cesarean section and 62 (18.3%) an emergency Cesarean section. No levator ani muscle injury was detected in any woman antenatally. After vaginal delivery, 57 (21.7% (95% CI, 16.7-26.7%)) women had levator ani muscle injury. The rates of injury for spontaneous vaginal delivery, ventouse extraction and forceps delivery were 15.4%, 33.3% and 71.4%, respectively. There was no levator ani muscle injury in the Cesarean section groups. Logistic regression analysis showed that only operative vaginal delivery (odds ratio, 3.09) was associated with an independent increase in the likelihood of levator ani muscle injury. Intrapartum epidural analgesics, duration of second stage of labor and infant birth weight were not independently associated with levator ani muscle injury. CONCLUSIONS The prevalence of levator ani muscle injury in Chinese women after their first vaginal delivery was 21.7% (95% CI, 16.7-26.7%). Operative vaginal delivery was found to increase the likelihood of women suffering such injury. A longer follow-up of these women and future studies on the effects of episiotomy are proposed.
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Affiliation(s)
- S S C Chan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Ouattara S, Some AD, Toure B, Bambara M, Dao B. Devenir materno-fœtal après application de ventouse obstétricale au centre hospitalier universitaire de Bobo-Dioulasso, Burkina Faso. ACTA ACUST UNITED AC 2012. [DOI: 10.4303/cmch/c120206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 2011; 159:43-8. [DOI: 10.1016/j.ejogrb.2011.06.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/14/2011] [Indexed: 11/20/2022]
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Gei AF, Pacheco LD. Operative vaginal deliveries: practical aspects. Obstet Gynecol Clin North Am 2011; 38:323-49, xi. [PMID: 21575804 DOI: 10.1016/j.ogc.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Forceps, vacuum, and cesarean sections are relatively recent additions to the obstetrician's armamentarium. The art of modern obstetrics is one that mandates from obstetricians the attentive vigilance of the development of natural processes and an active intervention when such processes fall outside normally accepted standards. What constitutes the "normal process" and the "accepted standard" is subject to discussion, and international variations in obstetric practice are in part the reflection of such controversies. This article presents a practical approach to the contemporary issue of instrumental deliveries, outlining supporting evidence (when available) and the most current position of professional colleges in obstetrics and gynecology.
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Affiliation(s)
- Alfredo F Gei
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Methodist Hospital of Houston, Houston, TX 77025, USA.
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Werkoff G, Morel O, Desfeux P, Gayat E, Akerman G, Tulpin L, Malartic C, Barranger E. [Kiwi vacuum extractor versus forceps and spatula: maternal and fetal morbidity evaluation in 169 fetal extractions]. ACTA ACUST UNITED AC 2010; 38:653-9. [PMID: 20971026 DOI: 10.1016/j.gyobfe.2010.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 06/18/2010] [Indexed: 11/30/2022]
Abstract
AIM To evaluate maternal and fetal complications resulting from the use of the Kiwi vacuum extractor and to compare them with those resulting from the use of forceps or spatula. PATIENTS AND METHODS Patients who had instrumental extraction between November 2006 and April 2007 were included in a unicentric retrospective study. Complications resulting from the use of Kiwi vacuum extractor and those of other instruments were compared. RESULTS One hundred and sixty-nine patients where included, 79 had extraction with Kiwi vacuum extractor. The two populations (women having extraction with Kiwi and woman having extraction with spatula or forceps) were similar in terms of maternal characteristics, progress of labour and delivery. The rate of episiotomies was significantly lower with KIWI (73.1% versus 94.4%; P=0.0001), as well as was postpartum haemorrhage rate (8.9 % versus 18.9%; P=0.04). No perineal tear of second or third degree occurred with Kiwi. Kiwi vacuum extractor was associated with a higher rate of shoulder dystocia (12.8% versus 6.7%, NS), but related fetal complication rates were similar in the two groups. The extraction failure rate was significantly higher with Kiwi (11.4% versus 4.4%; P=0.04), but cesarean section rate was similar for the two groups (1.3 % versus 4.4%). DISCUSSION AND CONCLUSION This study is the first comparing complications occurring after extraction with KIWI vacuum extractor to those occurring with other instruments. Although the results are limited by the retrospective nature of the study and the small size of the workforce, our study suggests that Kiwi vacuum extractor is associated with a lower rate of maternal complications and a rate of fetal complication similar to other kind of instruments. This instrument should be promoted and taught to younger patricians. Our study also revealed higher failure and shoulder dystocia rates. Larger studies are needed to better evaluate risks factor concerning these two complications in order to optimise the use of Kiwi vacuum extractor.
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Affiliation(s)
- G Werkoff
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 7501 Paris, France.
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Fritel X. Périnée et grossesse. ACTA ACUST UNITED AC 2010; 38:332-46. [DOI: 10.1016/j.gyobfe.2010.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 03/16/2010] [Indexed: 01/26/2023]
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Aouar Z, Ramanah R, Mangin M, Leung F, Mulin B, Courtois L, Cossa S, Maillet R, Riethmuller D. Morbidité materno-fœtale liée à l’extraction instrumentale par spatules de Teissier. Étude comparative à la ventouse obstétricale de type Minicup®. ACTA ACUST UNITED AC 2009; 38:642-7. [DOI: 10.1016/j.jgyn.2009.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Parant O, Simon-Toulza C, Capdet J, Fuzier V, Arnaud C, Rème JM. [Immediate fetal-maternal morbidity of first instrumental vaginal delivery using Thierry's spatulas. A prospective continuous study of 195 fetal extractions]. ACTA ACUST UNITED AC 2009; 37:780-6. [PMID: 19766049 DOI: 10.1016/j.gyobfe.2009.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 07/17/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the immediate fetal-maternal morbidity related to Thierry's spatula for first instrumental vaginal delivery. PATIENTS AND METHODS We conducted a prospective observational study in Toulouse university hospital, including primiparas who vaginally delivered a live singleton cephalic infant>36 WG, between December 2005 and June 2006. Instrumental deliveries were performed using short spatulas in all cases. Outcome measures were: perineal complications (episiotomy, laceration and associated lesions, urinary retention, pain at H48), neonatal morbidity (cutaneous injuries, neonatal transfer, cord pH, Apgar score). Instrumental deliveries were compared with spontaneous vaginal deliveries (SVD). RESULTS Six hundred and eight primiparas were included, distributed in 195 extractions (32%) and 413 SVD (68%). Spatulas allowed fetal extraction in all cases. Main differences between the two groups were: length of labour, occiput posterior position (12.8% for spatulas vs 1.7% for SVD; p<0.0001), episiotomy rate (97.9% vs 51.3%; p<0.0001), severe perineal lacerations (3.6% vs 0.2%; p=0.0007), post-partum morbidity (pain, hematoma, and urinary retention). No case of early severe neonatal complication was related to the use of the spatulas. DISCUSSION AND CONCLUSIONS Perineal complications (severe lacerations) associated with spatulas are increased with regard to SVD, but comparable to that reported with forceps. The main disadvantage is the high frequency of episiotomy, which should not be systematic. Neonatal morbidity is reduced. Comparative studies (spatulas vs. other procedures) are needed to confirm these data, but spatulas remain a multipurpose instrument which should continue to be taught.
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Affiliation(s)
- O Parant
- Service de gynécologie obstétrique, CHU Paule-de-Viguier, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France.
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