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Woon Wong K, Okeahialam N, Thakar R, Sultan AH. Obstetric risk factors for levator ani muscle avulsion: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 296:99-106. [PMID: 38422805 DOI: 10.1016/j.ejogrb.2024.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/15/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women. Conduct a meta-analysis identifying risk factors associated with LAM avulsion recognised on transperineal ultrasound (TPUS) or magnetic resonance imaging (MRI) in primiparous women after vaginal birth. STUDY DESIGN OVID Medline, Embase and the Cochrane Library from inception to January 2021 were searched. Review Manager 5.3 (The Cochrane Collaboration) was used to analyse data. Odds ratios (OR) with 95% confidence intervals (95% CIs) were calculated. The heterogeneity among studies was calculated using the I2statistic. RESULTS Twenty-five studies were eligible for inclusion (n = 9333 women). Major LAM avulsion was diagnosed in an average of 22 % (range 12.7-39.5 %) of cases. Twenty-two studies used TPUS and three used MRI to diagnose avulsion. Modifiable and non-modifiable risk factors were identified. Significant predictors identified were forceps (OR 6.25 [4.33 - 9.0]), obstetric anal sphincter injuries (OR 3.93 [2.85-5.42]), vacuum (OR 2.41 [1.40-4.16]), and maternal age (OR 1.06 [1.02-1.10]). CONCLUSIONS This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. This information could be used to develop a clinically applicable risk prediction model to target postnatal women at risk of LAM avulsion with a view to prevent the onset of pelvic floor organ prolapse.
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Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital, UK; St George's University of London, UK
| | - Abdul H Sultan
- Croydon University Hospital, UK; St George's University of London, UK.
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Li H, Zheng K, Wang H, Xie M. Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy. BMC Ophthalmol 2024; 24:80. [PMID: 38383362 PMCID: PMC10882915 DOI: 10.1186/s12886-024-03343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To compare the efficacy and efficiency of self-assembled intraocular rare earth magnet and forceps in removing intraocular foreign bodies(IOFBs) undergoing 25-gauge(G) pars plana vitrectomy. METHODS A total of 30 patients with metallic IOFB underwent 25-G PPV were enrolled into this study. Self-assembled intraocular rare earth magnet were used in 15 patients(bar group), and forceps were used in 15 patients(forceps group). Success rate of removing IOFB, time taken to remove IOFB, incidence of IOFB slippage and fall, iatrogenic retinal damages were compared between the two groups. RESULTS There was no significant difference in success rate of removing IOFBs between the groups(93.3% and 100%, P > 0.99). The median time taken of removing FB was significantly shorter in bar group than in forceps group(112 and 295 s, P = 0.001). None of the patients in bar group had IOFB slippage and fall, or related iatrogenic retinal damage in the process of removal. In forceps group, IOFB slippage and fall during removal were observed in 7 of 15(47.6%) patients, related iatrogenic retinal injuries were recorded in 6 of 15(40.0%) patients, both were significantly higher than bar group(P = 0.003 and P = 0.017, respectively). CONCLUSIONS Compared with forceps, the assembled intraocular magnet can greatly reduce the possibility of IOFB slippage and fall, prevent related iatrogenic retinal damage, and shorten the time taken to remove IOFB. The assembled intraocular magnet can be an useful tool in removing metallic IOFBs in PPV.
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Affiliation(s)
- Huajin Li
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, 350005, Fuzhou, China
| | - Kailing Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, 350005, Fuzhou, China
| | - Huihang Wang
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, 350005, Fuzhou, China
| | - Maosong Xie
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, 350005, Fuzhou, China.
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Chawanpaiboon S, Titapant V, Pooliam J. Maternal complications and risk factors associated with assisted vaginal delivery. BMC Pregnancy Childbirth 2023; 23:756. [PMID: 37884886 PMCID: PMC10601252 DOI: 10.1186/s12884-023-06080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery. METHODS We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered. RESULTS The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01-2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30-20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09-6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01-1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23-7.43; P = 0.016). CONCLUSIONS The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%). CLINICAL TRIAL REGISTRATION Thai Clinical Trials Registry: 20220126004.
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Affiliation(s)
- Saifon Chawanpaiboon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.
| | - Vitaya Titapant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Julaporn Pooliam
- Clinical Epidemiological Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:238-246. [DOI: 10.13105/wjma.v11.i5.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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Mebratu A, Ahmed A, Zemeskel AG, Alemu A, Temesgen T, Molla W, Figa Z. Prevalence, indications and fetal outcomes of operative vaginal delivery in Sub-Saharan Africa, systematic review, and meta-analysis. BMC Womens Health 2023; 23:95. [PMID: 36894978 PMCID: PMC9996922 DOI: 10.1186/s12905-023-02224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis is intended to assess the prevalence, indications, and fetal outcome of operative vaginal delivery in sub-Saharan Africa. METHOD In this study, 17 studies with a total population of 190,900 were included in both systematic review and meta-analysis. Search for relevant articles was done by using international online databases (like Google Scholar, PubMed, HINARI, EMBASE, Web of Science, and African journals) and online repositories of Universities in Africa. The JOANNA Briggs Institute standard data extraction format was used to extract and appraise high-quality articles before being included in this study. The Cochran Q and I2 statistical tests were used to test the heterogeneity of the studies. The publication bias was tested by a Funnel plot and Egger's test. The overall pooled prevalence, indications, and fetal outcome of operative vaginal delivery along a 95% CI using forest plots and tables. RESULT The overall pooled prevalence of operative vaginal delivery in sub-Saharan Africa was 7.98% (95% CI; 5.03-10.65; I2 = 99.9%, P < 0.001). The indications of operative vaginal delivery in sub-Saharan African countries include the prolonged second stage of labor 32.81%, non-reassuring fetal heart rate 37.35%, maternal exhaustion 24.81%, big baby 22.37%, maternal cardiac problems 8.75%, and preeclampsia/eclampsia 2.4%. Regarding the fetal outcome, favourable fetal outcomes were 55% (95% CI: 26.04, 84.44), p = < 0.56, I2: 99.9%). From those births with unfavourable outcomes, the need for the resuscitation of new-born was highest 28.79% followed by poor 5th minute Apgar score, NICU admission, and fresh stillbirth, 19.92, 18.8, and 3.59% respectively. CONCLUSION The overall prevalence of operative vaginal delivery (OVD) in sub-Saharan Africa was slightly higher compared to other countries. To reduce the increased applications and adverse fetal outcomes of OVD, capacity building for obstetrics care providers and drafting guidelines are required.
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Affiliation(s)
- Andualem Mebratu
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Abbas Ahmed
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Addisu Getnet Zemeskel
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Asrat Alemu
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Tesfaye Temesgen
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Wondwosen Molla
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia
| | - Zerihun Figa
- Dilla University College of the Health and Medical Science Department of Midwifery, PO. BOX 419, Dilla, Ethiopia.
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Dietz HP, Low G, Shek KL. Obstetric risk factors for anal sphincter trauma in a urogynecological population. Int Urogynecol J 2023; 34:425-430. [PMID: 36374329 DOI: 10.1007/s00192-022-05404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter tears are the single major modifiable risk factor for anal incontinence (AI) in women. We undertook a retrospective observational study in a tertiary urogynecology unit to describe the prevalence of sonographic anal sphincter defects in a urogynecological population and investigate obstetric risk factors. METHODS Files of women seen for investigation of pelvic floor disorders between January 2014 and May 2021 were reviewed. Sonographic defects of the external anal sphincter were analyzed using stored 4D ultrasound imaging data. Explanatory parameters were number of vaginal births, delivery mode, age at first vaginal birth, and birthweight of the first vaginally born baby. RESULTS Of 3,037 women seen during the inclusion period, data were missing in 219, leaving 2,818. AI was reported by 508 (18%), with a mean St Marks score of 11 (1-23) and a mean bother score of 5.9 (0-10). External sphincter defects were detected in 945 women (34%), with a "residual defect" in 343 (12%). The strongest risk factors for a residual defect were first vaginal birth and forceps, with higher-order multiparity adding risk. On multivariate analysis, forceps and vaginal parity >5 remained significant predictors, as opposed to age at first birth and birthweight of the firstborn. CONCLUSIONS In this observational study in urogynecological patients, 12% showed a residual EAS defect on imaging. The most obvious risk factors for the diagnosis of a residual defect on exo-anal imaging were the first vaginal birth and forceps, with higher-order vaginal parity conveying additional risk.
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Affiliation(s)
- Hans Peter Dietz
- Sydney Urodynamic Centres, Suite 2, Level 1 56 Kitchener Pde, Bankstown, NSW, 2200, Australia.
| | - Gary Low
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ka Lai Shek
- Sydney Urodynamic Centres, Suite 2, Level 1 56 Kitchener Pde, Bankstown, NSW, 2200, Australia
- Obstetrics and Gynaecology, Western Sydney University, Sydney, New South Wales, Australia
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Tarar ZI, Farooq U, Bechtold ML, Ghouri YA. Cap-assisted endoscopy for esophageal foreign bodies: A meta-analysis. World J Meta-Anal 2023; 11:38-46. [DOI: 10.13105/wjma.v11.i1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/11/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Esophageal foreign bodies are common around the world. Newer approaches, such as cap-assisted endoscopy, have been introduced as an alternative to conventional methods. Therefore, we performed a meta-analysis ono cap-assisted endoscopy versus conventional endoscopy for removal of esophageal foreign bodies.
AIM To investigated the effectiveness of cap-assisted endoscopy with conventional endoscopy.
METHODS An extensive literature search was performed (December 2021). For esophageal foreign body removal, cap-assisted endoscopy was compared to conventional endoscopy for procedure time, technical success of the procedure, time of foreign body retrieval, en bloc removal, and adverse event rate using odds ratio and mean difference.
RESULTS Six studies met the inclusion criteria (n = 1305). Higher odds of technical success (P = 0.002) and en bloc removal (P < 0.01) and lower odds of adverse events (P = 0.02) and foreign body removal time (P < 0.01) were observed with cap-assisted endoscopy as compared to conventional techniques.
CONCLUSION For esophageal foreign bodies, the technique of cap-assisted endoscopy demonstrated increased en bloc removal and technical success with decreased time and adverse events as compared to conventional techniques.
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Affiliation(s)
- Zahid Ijaz Tarar
- Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Umer Farooq
- Department of Medicine, Loyola University, Chicago, IL 60153, United States
| | - Matthew L Bechtold
- Department of Medicine, University of Missouri - Columbia, Columbia, MO 65212, United States
| | - Yezaz A Ghouri
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
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Shetye OA, Mandrekar PN, Khandeparker RV, Fernandes TB, Dhupar V, Akkara F. Intra-alveolar extraction of linguoverted mandibular premolars - the Shetye technique: a technical note. J Korean Assoc Oral Maxillofac Surg 2022; 48:242-244. [PMID: 36043256 PMCID: PMC9433858 DOI: 10.5125/jkaoms.2022.48.4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/04/2022] [Accepted: 06/23/2022] [Indexed: 11/07/2022] Open
Abstract
Extraction of premolars for orthodontic purposes may prove challenging when the tooth is blocked or lingualised. The standard buccal approach may prove difficult in such cases. A novel technique was used for 16 patients with healthy linguoverted mandibular premolars using maxillary extraction forceps. The ease of extraction increased and resulted in uneventful postoperative healing in all patients. The authors suggest this as a preferred technique for extracting mandibular premolars in linguoversion.
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Affiliation(s)
- Omkar Anand Shetye
- Department of Oral and Maxillofacial Surgery, Goa Dental College & Hospital, Bambolim, India
| | | | | | | | - Vikas Dhupar
- Department of Oral and Maxillofacial Surgery, Goa Dental College & Hospital, Bambolim, India
| | - Francis Akkara
- Department of Oral and Maxillofacial Surgery, Goa Dental College & Hospital, Bambolim, India
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Shimalis C, Hasen T, Regasa MT, Desalegn Z, Mulisa D, Upashe SP. Complications of instrumental vaginal deliveries and associated factors in hospitals of Western Oromia, Ethiopia. SAGE Open Med 2022; 10:20503121221113091. [PMID: 35898956 PMCID: PMC9310291 DOI: 10.1177/20503121221113091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: In developing countries like Ethiopia, there is lack of evidence that shows the magnitude and factors affecting complications of instrumental delivery. Most of the research done in Ethiopia was secondary data and lacks variables like socio-demographic factors, availability of cardiotocograph, number of traction, and who conducted delivery (qualification of health workers). So, this study tried to fill the gaps by conducting primary research with secondary data and adding those variables stated above. Methods: Health facility-based cross-sectional study was conducted from 20 February 20 June 2020 in five public hospitals in East Wollega Zone. Single population proportion formula used to calculate sample size. Systematic random sampling was employed. Interviewer-administered structured questionnaire, checklist, and document review were used to collect data from 282 respondents. Data entered to Epi Data version 3.01 and exported to a statistical package of social sciences version 21 for analysis. Those variables with p < 0.25 in the bivariate analyses were a candidate for multivariable logistic regression and multivariable logistic regression was done to identify factors associated with complications of instrumental vaginal delivery using 95% confidence interval and p < 0.05. Results: Complications of instrumental vaginal delivery were 37.2%. Out of all neonates delivered by operative vaginal delivery, 69 (24.5%) developed complications. Vacuum-assisted delivery (adjusted odd ratio = 0.245, 95% confidence interval 0.092–0.658), 120–160 fetal heartbeats per minute (adjusted odd ratio = 0.298, 95% confidence interval 0.114–0.628), birthweight > 4000 g (adjusted odd ratio = 4.09, 95% confidence interval 1.729–9.499) and outlet instrumentation (adjusted odd ratio = 0.139, 95% confidence interval 0.057–0.339) were associated with complications of instrumental vaginal delivery. Conclusion: Magnitude of complications of instrumental vaginal delivery was high in the study area. So, health professionals should give due attention on instrument selection and application. Instrumental delivery requires a careful assessment of clinical circumstances to identify the indications and contraindications for the application of the instruments.
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Affiliation(s)
- Chaltu Shimalis
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Tahir Hasen
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Misganu Teshoma Regasa
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Zelalem Desalegn
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Diriba Mulisa
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Shivaleela P Upashe
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,Department of Child Health Nursing, Nitte Usha Institute of Nursing Sciences, Nitte (Deemed to be), Mangaluru, India
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Fudman DI, Singal AG, Cooper MG, Lee M, Murphy CC. Prevalence of Forceps Polypectomy of Nondiminutive Polyps Is Substantial But Modifiable. Clin Gastroenterol Hepatol 2022; 20:1508-1515. [PMID: 34839039 PMCID: PMC9133266 DOI: 10.1016/j.cgh.2021.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The use of forceps for removal of nondiminutive polyps is associated with incomplete resection compared with snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for nondiminutive polyps or identified strategies to improve this practice. To address this gap, we estimated the prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multicomponent intervention to reduce inappropriate forceps polypectomy. METHODS We retrospectively reviewed all colonoscopies with polypectomies performed at 2 U.S. health systems between October 1, 2017, and September 30, 2019. We used a mixed-effects logistic regression model to examine the effect of a multicomponent intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5 mm. RESULTS A total of 9968 colonoscopies with 25,534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n = 2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (odds ratio [OR], 0.34, 95% confidence interval [CI], 0.30-0.39), from 11.4% (n = 1539) to 5.3% (n = 637). Predictors of inappropriate forceps polypectomy included inadequate bowel prep (OR, 1.25; 95% CI, 1.06-1.47), polyps in the right colon (vs left: OR, 1.29; 95% CI, 1.09-1.51), and number of polyps removed (OR, 0.96; 95% CI, 0.94-0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median OR, 3.43). In a post hoc analysis, the proportion of polyps >2 mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR, 0.62; 95% CI, 0.58-0.68). CONCLUSIONS Inappropriate forceps polypectomy is common but modifiable. The proportion of nondiminutive polyps removed with forceps polypectomy should be considered as a quality measure.
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Affiliation(s)
- David I. Fudman
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center,Department of Population and Data Sciences, University of Texas Southwestern Medical Center
| | - Mark G. Cooper
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center
| | - MinJae Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth)
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Adeli SH, Sehat M, Azarnia Samarin G, Vafaeimanesh J, Ahmadpour S, Nasiri S. Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report. BMC Gastroenterol 2022; 22:9. [PMID: 34991483 PMCID: PMC8739710 DOI: 10.1186/s12876-021-02080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 12/22/2021] [Indexed: 05/31/2023] Open
Abstract
Background Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. Case presentation A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. Conclusions Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.
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Affiliation(s)
- Seyed-Hasan Adeli
- Department of Internal Medicine, School of Medicine, Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Malihe Sehat
- Department of Anesthesiology, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Gholamreza Azarnia Samarin
- Department of Orthopedics, School of Medicine, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Jamshid Vafaeimanesh
- Department of Internal Medicine, School of Medicine, Gastroenterology and Hepatology Diseases Research Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Sajjad Ahmadpour
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sara Nasiri
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran.
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Takahashi M, Yoshimura S, Takyu S, Aikou S, Okumura Y, Yagi K, Fukayama M, Momose T, Seto Y, Yamaya T. A design of forceps-type coincidence radiation detector for intraoperative LN diagnosis: clinical impact estimated from LNs data of 20 esophageal cancer patients. Ann Nucl Med 2021; 36:285-292. [PMID: 34843102 PMCID: PMC8897350 DOI: 10.1007/s12149-021-01701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Abstract
Purpose To reduce postoperative complications, intraoperative lymph node (LN) diagnosis with 18F-fluoro-2-deoxy-D-glucose (FDG) is expected to optimize the extent of LN dissection, leading to less invasive surgery. However, such a diagnostic device has not yet been realized. We proposed the concept of coincidence detection wherein a pair of scintillation crystals formed the head of the forceps. To estimate the clinical impact of this detector, we determined the cut-off value using FDG as a marker for intraoperative LN diagnosis in patients with esophageal cancer, the specifications needed for the detector, and its feasibility using numerical simulation. Methods We investigated the dataset including pathological diagnosis and radioactivity of 1073 LNs resected from 20 patients who underwent FDG-positron emission tomography followed by surgery for esophageal cancer on the same day. The specifications for the detector were determined assuming that it should measure 100 counts (less than 10% statistical error) or more within the intraoperative measurement time of 30 s. The detector sensitivity was estimated using GEANT4 simulation and the expected diagnostic ability was calculated. Results The cut-off value was 620 Bq for intraoperative LN diagnosis. The simulation study showed that the detector had a radiation detection sensitivity of 0.96%, which was better than the estimated specification needed for the detector. Among the 1035 non-metastatic LNs, 815 were below the cut-off value. Conclusion The forceps-type coincidence detector can provide sufficient sensitivity for intraoperative LN diagnosis. Approximately 80% of the prophylactic LN dissections in esophageal cancer can be avoided using this detector.
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Affiliation(s)
- Miwako Takahashi
- Department of Advanced Nuclear Medicine Sciences, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
- Department of Nuclear Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuntaro Yoshimura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sodai Takyu
- Department of Advanced Nuclear Medicine Sciences, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimitsu Momose
- Department of Nuclear Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taiga Yamaya
- Department of Advanced Nuclear Medicine Sciences, Institute for Quantum Medical Science, National Institutes for Quantum and Radiological Science and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
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Hotton EJ, Renwick S, Lenguerrand E, Wade J, Draycott TJ, Crofts JF, Blencowe NS. Exploring the reporting standards of RCTs involving invasive procedures for assisted vaginal birth: A systematic review. Eur J Obstet Gynecol Reprod Biol 2021; 262:166-173. [PMID: 34023718 PMCID: PMC8250286 DOI: 10.1016/j.ejogrb.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Assisted vaginal birth (AVB) is a complex intervention involving medical devices, comprising multiple components. This complexity creates difficulties when designing and conducting randomised controlled trials (RCTs), in terms of describing, standardising and monitoring the intervention, and accounting for differing clinician expertise. This review examines the reporting standards of complex interventions involving a medical device, in the context of AVB RCTs. STUDY DESIGN Searches were undertaken from the start of indexing to March 2021, and limited to RCTs, feasibility and pilot studies including at least one device for AVB. RCTs were selected if they included participants having an AVB with any device, with or without a comparator group. Reporting details were assessed according to the Consolidating Standards of Reporting Trials extension for non-pharmacological treatments (CONSORT-NPT), focusing on intervention descriptions, standardization, adherence and clinician expertise. Screening of abstracts, full-text articles and data extraction was performed by two independent reviewers. RESULTS Of 4098 abstracts and 83 full-text articles, 39 papers were included, investigating 80 interventions. Twenty-seven different named devices were identified. Intervention descriptions were provided in 20 (55%) papers with varying levels of detail and with only one covering the entire procedure. Standardization of interventions was mentioned in 25 papers (64%). Only eight (21%) papers reported any form of adherence to the intended procedure. Some data regarding expertise were reported in 25 (64%) papers. CONCLUSIONS Despite some compliance with reporting standards, there is a lack of detail regarding intervention description, standardization, adherence and expertise in RCTs of AVB. This creates difficulties in understanding how intervention delivery was intended and what actually occurred. Clearer guidelines for the reporting of invasive procedures and devices are required.
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Affiliation(s)
- Emily J Hotton
- Translational Health Sciences, University of Bristol, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Sophie Renwick
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Bristol, UK; Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Tim J Draycott
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Natalie S Blencowe
- Centre for Surgical Research, Population Health Sciences, University of Bristol, Bristol, UK; University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Abstract
Damage to the pelvic floor during pregnancy and vaginal delivery is an inevitable consequence of the natural birthing process. As this damage is associated with functional and anatomical problems in later life, minimizing pelvic floor damage during pregnancy and vaginal delivery may serve as an important factor in the prevention of these unwanted sequelae. Operative vaginal delivery using forceps or vacuum extractor is common practice to achieve or expedite vaginal birth for maternal or fetal indications such as maternal exhaustion or fetal distress. However, operative vaginal delivery is associated with more extensive damage to the pelvic floor and perineal structures with forceps carrying a stronger risk compared to vacuum. The evidence on this subject is discussed with possible suggestions to minimize pelvic floor damage as much as possible.
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Affiliation(s)
- Jan Willem de Leeuw
- Department of Obstetrics and Gynaecology, Ikazia Ziekenhuis, Montessoriweg 1, 3083, AN, Rotterdam, The Netherlands.
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Sunshine Hospital, Western Health, Melbourne, Australia
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Wu L, Wang H, Fan F, You J. "The You-Adson-Brown Forceps": A quantifiable instrument for graft fixation. J Plast Reconstr Aesthet Surg 2021; 74:2392-2442. [PMID: 33879417 DOI: 10.1016/j.bjps.2021.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/12/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Lehao Wu
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. 33rd Badachu Road, Shijingshan District, Beijing, China
| | - Huan Wang
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. 33rd Badachu Road, Shijingshan District, Beijing, China
| | - Fei Fan
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. 33rd Badachu Road, Shijingshan District, Beijing, China
| | - Jianjun You
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. 33rd Badachu Road, Shijingshan District, Beijing, China.
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Ozsaygili C, Bayram N. Comparison of Anatomical and Functional Results of Surgeries Performed with Nitinol Flex Loop or Forceps in Primary Epiretinal Membrane. Semin Ophthalmol 2021; 36:507-516. [PMID: 33734940 DOI: 10.1080/08820538.2021.1890786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To compare surgery's effect with nitinol flex loop (NFL) or forceps on retinal layers and functional outcomes in the primary epiretinal membrane (ERM).Methods: The operations were classified according to the use of the NFL or forceps. Automatic segmentation of the individual inner retinal layers was performed by spectral-domain optical coherence tomography software, and best-corrected visual acuity (BCVA) before surgery and at the last follow-up visit postoperatively were compared.Results: Forty-two eyes of 42 patients were included with a mean age of 66.9 ± 5.7 years. 45.2% of the surgeries were NFL assisted, 54.8% were forceps assisted. The mean follow-up duration was 9.8 ± 1.3 months. The mean BCVA was 0.79 ± 0.42 vs 0.77 ± 0.39 logMAR in the preoperative period and 0.42 ± 0.27 vs. 0.40 ± 0.21 logMAR at last follow-up in the NFL vs forceps group respectively (p= .403). The retinal nerve fiber layer (RNFL)(32.5% vs. 50.1%, p= .009), ganglion cell layer (18.1% vs. 41.4%, p= .021), inner plexiform layer (13.5% vs. 32.7%, p= .031) and inner nuclear layer (15.5% vs. 30.3%, p= .011) thickness decreased significantly more in the forceps group. The mean surgical time was not significantly different (45.2 ± 5.1 vs. 51.1 ± 6.1 minutes) in the NFL vs. forceps groups, respectively (p= .331).Conclusion: Following primary ERM surgery, the inner retinal layers become thinner; RNFL impacted the most, which was found higher in forceps assisted surgeries. This result shows that the NFL can be used safely in macular surgery.
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Affiliation(s)
- Cemal Ozsaygili
- Department of Ophthalmology, Kayserı City Training and Research Hospital, Kocasinan, Kayseri, TURKEY
| | - Nurettin Bayram
- Department of Ophthalmology, Kayserı City Training and Research Hospital, Kocasinan, Kayseri, TURKEY
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Gieche JM. Equine Oral Extraction Techniques. Vet Clin North Am Equine Pract 2020; 36:545-64. [PMID: 33189232 DOI: 10.1016/j.cveq.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article serves as a template for equine veterinarians to become proficient in basic intraoral premolar and molar extraction techniques of Equidae. Indications, equipment, and methodology are described. Numerous photos and videos are included to achieve a more immersive learning experience than can be accomplished with the written word alone. Clinicians performing these techniques will continue to improve their skillsets to achieve positive outcomes as case specifics become more challenging.
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18
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Evans MI, Britt DW, Evans SM. Mid forceps did not cause "compromised babies" - "compromise" caused forceps: an approach toward safely lowering the cesarean delivery rate. J Matern Fetal Neonatal Med 2021; 35:5265-5273. [PMID: 33494634 DOI: 10.1080/14767058.2021.1876657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Over 5 decades, Cesarean Delivery rates (CDR) have risen 6-fold while vaginal operative deliveries [VODs] decreased from >20% to ∼3%. Poor outcomes (HIE and cerebral palsy) haven't improved. Potentiating the virtual abandonment of forceps (F), particularly midforceps (Mid), were allegations about various poor neonatal outcomes. Here, we evaluate VOD and CDR outcomes controlling for prior fetal risk metrics (PR) ascertained an hour before birth. METHODS Our 45-year-old database from a labor research unit of moderate/high risk laboring patients (288 NSVDs, 120 Lows, 30 Mids, and 32 CDs) had multiple fetal scalp samples for base excess (BE), pH, cord blood gases (CB), and umbilical artery bloods. ANOVA established relationships between birth methods and outcomes (Cord blood BE and pH and 1 and 5 min Apgar scores); correlations, and two-step multiple regression assessed PR for delivery method and neonatal outcomes. The main outcome measures were correlations of outcome measures with fetal scalp sample BE and pH up to an hour before delivery and fetal reserve index scores scored concurrently. RESULTS NSVDs had the best immediate neonatal outcomes with significantly higher CB pH and BE as compared to forceps and CDs. However, controlling for PR revealed: (1) PR at 1 h before delivery correlated with delivery mode, i.e. the decrements in outcomes were already present before the delivery was performed; and (2) The presumed deleterious effects of interventional deliveries, per se, were significantly reduced, and (3) Fetal Reserve Index predicted neonatal outcomes better than fetal scalp sample BE, pH, or delivery mode. CONCLUSION The historical belief that MF deliveries caused poorer outcomes than NSVDs seems mostly backwards. Appreciating PR's impact on delivery routes, and when appropriate, properly performing VODs could safely reduce CDR. If our approach lowered CDR by only ∼2%, in the United States about 80,000 CDs might be avoided, saving ∼$750 Million yearly. In the post pandemic world, safely apportioning medical expenses will be even more critical than previously.
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Affiliation(s)
- Mark I Evans
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA.,Department of Obstetrics & Gynecology, Icahn School of Medicine at Mt Sinai, Mt Sinai, NY, USA
| | - David W Britt
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA
| | - Shara M Evans
- Comprehensive Genetics, Fetal Medicine Foundation of America, New York, NY, USA.,Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lebraud M, Griffier R, Hmila S, Aubard Y, Gauthier T, Parant O, Guerby P. Comparison of maternal and neonatal outcomes after forceps or spatulas-assisted delivery. Eur J Obstet Gynecol Reprod Biol 2020; 258:126-131. [PMID: 33421809 DOI: 10.1016/j.ejogrb.2020.12.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare the perinatal outcomes associated with spatulas or forceps assisted delivery. STUDY DESIGN This is a bicentric retrospective cohort study including all assisted deliveries in cephalic presentation after 37 weeks of gestation, performed on singleton pregnancy with forceps and with spatulas in two tertiary centers. The main outcome was the rate of episiotomy. Secondary outcomes included obstetric anal sphincter injuries (OASIS), maternal outcomes and neonatal parameters. RESULTS Out of 37 002 deliveries, the overall rate of assisted delivery was 11.4 %, and 1 041 (2.8 %) assisted deliveries with forceps and 2 462 (6.7 %) spatulas deliveries were included. The rate of episiotomy was 90.3 % after forceps-assisted delivery and 70.9 % for spatulas (p < 0.001). The rate of OASIS was 7.2 % and 5.6 % respectively (p = 0.06). A slight but significant decrease in neonatal trauma after spatulas was observed. CONCLUSION In this retrospective cohort study, the episiotomy rate was higher with forceps assisted deliveries than with spatulas. Both instruments have low neonatal morbidity and are similar regarding OASIS.
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Affiliation(s)
- Margaux Lebraud
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France
| | - Romain Griffier
- Department of Public Health, CHU Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Salwa Hmila
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Yves Aubard
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Tristan Gauthier
- Department of Obstetrics and Gynecology, Hôpital de la mère et de l'enfant, 8 Avenue Dominique Larrey, 87000 Limoges, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, 330 avenue de Grande-Bretagne TSA 70034, 31059 Toulouse, France; Université Paul-Sabatier Toulouse III, 31330 Toulouse, France.
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Rachaneni S, Gurol-Urganci I, Basu M, Thakar R, Sultan A, Freeman R. Short statured primigravidae: Options for the obstetric management from a survey of UK obstetricians. Eur J Obstet Gynecol Reprod Biol 2021; 256:379-84. [PMID: 33279806 DOI: 10.1016/j.ejogrb.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the current antenatal and intrapartum management options for primigravid women of short stature with a clinically large fetus by a survey of UK Obstetricians. STUDY DESIGN An online survey comprised of 15 questions including the options on timing and mode of delivery, counselling about the risk of long-term pelvic floor morbidity following spontaneous vaginal and instrumental deliveries, choice of instruments and the role of episiotomy. The survey was sent to the participants as a part of Royal College of Obstetricians and Gynaecologists (RCOG) Newsletter between September 2017 to October 2018. The scenario described was of a primigravid short stature woman (i.e. height of 160 cm or less) who presents with a clinically large fetus at 38 weeks gestation. RESULTS 424 Obstetricians participated in the survey. The participation ratio cannot be identified as the survey was emailed as a part of the RCOG Newsletter. Sixty five percent respondents stated that they would scan for estimated fetal weight, 48 % would offer induction of labour at 40 weeks and 14 % would offer an elective/planned caesarean section (CS) at 39-40 weeks. Fifty nine percent would discuss all these risks: obstructed labour, shoulder dystocia, instrumental delivery and obstetric anal sphincter injury (OASI). 73 % would not discuss the long-term risks of urinary and/or faecal incontinence and pelvic organ prolapse. In the presence of failure to progress in the second stage of labour, 69 % would attempt a rotational instrumental delivery and 5% would offer a caesarean section. Manual rotation and 'straight' forceps application were the most frequent type of rotational delivery, followed by Ventouse and Kiellands forceps. Thirty four percent stated that they do not routinely perform an episiotomy in this scenario. Seventy three percent stated that their choice of instrument was not based on the long-term risk of urinary and faecal incontinence. CONCLUSION The results suggest that 40 % of the respondents would not discuss all of the complications after vaginal delivery in women of short stature. The most common delivery option would be vaginal delivery.
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21
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Chenal L, Gebeile-Chauty S. [Does instrumental delivery have an influence on the need for orthodontic treatment?]. Orthod Fr 2020; 91:197-207. [PMID: 33146615 DOI: 10.1684/orthodfr.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The objective of this comparative retrospective cohort performed on 202 patients was to evaluate the influence of instrumental extraction (forceps, suction cup, spatula) during delivery on the need for orthodontic treatment. Questionnaires on the type of delivery were distributed in three different structures. The need for treatment was assessed using the IOTN indicator (Index of Orthodontic Treatment Need). The groups were compared by statistical tests at the significance level of 5 %. 202 patients were included (51 in the group « instrumental delivery », 151 in the control group). With an average IOTN of 3.3 in the « instrumental delivery » group versus 2.5 in the « non-instrumental delivery » group, the difference between the two groups is statistically significant (p = 0.00015). Since the need for orthodontic treatment is significantly higher in patients born by instrumental delivery compared to patients born without instrumental support, instrumental extraction is therefore a risk factor in orthodontics, diagnosis and orthodontic treatment may be indicated in these patients. In addition, provided that it is proven effective, early osteopathic management may be recommended.
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Affiliation(s)
- Lucie Chenal
- Département d'orthodontie, Faculté d'Odontologie, rue Guillaume Paradin, 69372 Lyon cedex 08, France, Unité Fonctionnelle d'Orthopédie Dento-Faciale, Centre de Traitements Dentaires, Hospices Civils de Lyon, 3 quai des Célestins, 69002 Lyon, France
| | - Sarah Gebeile-Chauty
- Département d'orthodontie, Faculté d'Odontologie, rue Guillaume Paradin, 69372 Lyon cedex 08, France, Unité Fonctionnelle d'Orthopédie Dento-Faciale, Centre de Traitements Dentaires, Hospices Civils de Lyon, 3 quai des Célestins, 69002 Lyon, France, 56 rue de la république, 69150 Décines-Charpieu, France
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Diaz-Aljaro P, Monés-Liivina A, Romanic-Bubalo N, Castillo Capponi F, Sabala-Llopart A. Management of Descemet membrane detachment secondary to forceps assisted delivery in a newborn. Arch Soc Esp Oftalmol (Engl Ed) 2020; 95:447-450. [PMID: 32616372 DOI: 10.1016/j.oftal.2020.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
To describe the clinical signs and management of Descemet membrane (DM) detachment after forceps-related trauma during birth. A 2-day-old term infant presented with right eye corneal clouding and history of forceps assisted delivery. Ophthalmic assessment was consistent for corneal trauma and anterior segment optical coherence tomography (AS-OCT Visante®) revealed DM detachment. Prolonged topical treatment considerably reduced edema, but after four months of treatment superior DM detachment persisted, anterior chamber air injection at this point also failed to achieve apposition. Central visual axis remained partially spared in the months to follow, and intensive amblyopia treatment was indicated. Prolonged topical treatment may be helpful to reduce edema and risk of severe amblyopia in DM tears secondary to forceps traumatism at birth, but insufficient in cases of large DM detachment.
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Affiliation(s)
- P Diaz-Aljaro
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - A Monés-Liivina
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - N Romanic-Bubalo
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - F Castillo Capponi
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Sabala-Llopart
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Caudwell Hall J, Shek C, Langer S, Dietz HP. The effect of replacing vacuum with forceps in operative vaginal delivery: an observational study. Int Urogynecol J 2020; 31:1771-6. [PMID: 32535687 DOI: 10.1007/s00192-020-04352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS An increase in vaginal delivery with forceps may increase rates of pelvic floor trauma. This study was designed to predict trauma rates resulting from policies preferencing forceps. METHODS This is an observational cohort study utilizing data from 660 primiparae enrolled in an RCT in two tertiary obstetric units in Sydney, Australia. Participants were assessed clinically and with 4D translabial ultrasound in the late third trimester and again at 3-6 months postpartum. Incidence of trauma associated with mode of delivery was adjusted to reflect change associated with a conversion of vacuum to forceps delivery. Primary outcome measures were third-/fourth-degree tear, levator avulsion (LA) and external anal sphincter (EAS) trauma diagnosed sonographically. RESULTS Five hundred four women were seen at a mean of 5.1 (2.3-24.3) months postpartum. After exclusion of 21 because of missing data, 483 women were analysed: 112 (23%) had a CS, 268 (55%) a normal vaginal delivery (NVD), 69 (14%) a vacuum (VD) and 34 (7%) a forceps (FD). One hundred fifty-two women had EAS trauma and/or LA; 17 sustained both. After VD, 32/69 (46%) women suffered LA and/or EAS trauma; after FD, it was 33/34 (97%). Converting VD to FD was estimated to result in an increase in trauma from 152/483 (31%) to 187/483 (39%). A formula can be generated based on local obstetric and ultrasound data to estimate trauma incidence. CONCLUSIONS A change in obstetric practice resulting in the conversion of primary VD to primary FD would be expected to substantially increase the likelihood of pelvic floor trauma.
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Ning J, Xie Y. A new type of forceps for stabilizer removal after NUSS procedure. J Pediatr Surg 2020; 55:1139-1141. [PMID: 31859044 DOI: 10.1016/j.jpedsurg.2019.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
This paper describes the design and application of a new type of forceps for stabilizer removal after NUSS procedure. The forceps are made up of two strips of streamline forceps, which is composed of forceps handle and forceps head. One forceps head was designed as "Y" shaped, with an "L" shaped convex teeth set on each tip. It protrudes a small cylinder on the end platform of the other forceps head. Compared to the traditional operation method, with utilization of the forceps for stabilizer removal, it is expected that the operation time will be shortened and the bleeding will be reduced. The clinical application showed a good value of using the forceps in stabilizer removal after NUSS procedure. LEVEL OF EVIDENCE: Level III.
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Affiliation(s)
- Jinbo Ning
- 165, Xincheng Road, Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital, Wanzhou District, Chongqing, China.
| | - Yimin Xie
- 165, Xincheng Road, Department of Pediatric Surgery, Chongqing Three Gorges Central Hospital, Wanzhou District, Chongqing, China.
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Cassadó J, Simó M, Rodríguez N, Porta O, Huguet E, Mora I, Girvent M, Fernández R, Gich I. Prevalence of levator ani avulsion in a multicenter study (PAMELA study). Arch Gynecol Obstet 2020; 302:273-280. [PMID: 32449062 DOI: 10.1007/s00404-020-05585-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective is to determine the prevalence of levator ani muscle (LAM) avulsion using four-dimensional ultrasound in primiparous women after vaginal delivery and according to delivery mode. METHODS This prospective, multicenter study included 322 women evaluated at 6-12 months postpartum by four-dimensional transperineal ultrasound to identify levator ani muscle avulsion. The researcher who performed the ultrasound was blinded to all clinical data. Meaningful data about the birth were also recorded: mode of delivery, mother's age and body mass index, duration of second stage, episiotomy, perineal tearing, anesthesia, assistant, head circumference and fetal weight. RESULTS 303 volumes were valid for evaluation. The overall prevalence of levator ani muscle avulsion was 18.8% (95% CI 14.4-23.2%). In our multivariate analysis, only mode of delivery reached statistical significance as a risk factor for levator ani muscle avulsion (p < 0.001). The prevalence according to the different modes of delivery was 7.8% in spontaneous delivery, 28.8% in vacuum-assisted and 51.1% in forceps-assisted delivery. Compared with spontaneous delivery, the OR for LAM avulsion was 12.31 with forceps (CI 95% 5.65-26.80) and 4.78 with vacuum-assisted delivery (CI 95% 2.15-10.63). CONCLUSIONS Levator ani avulsion during vaginal delivery in primiparous women occurs in nearly one in every five deliveries. Delivery mode is a significant and modifiable intrapartum risk factor for this lesion. The incidence is lower in spontaneous delivery and significantly increases when an instrument is used to assist delivery, especially forceps.
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Affiliation(s)
- Jordi Cassadó
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Plaça Dr. Robert, 4, 08221, Terrassa, Spain.
| | - Marta Simó
- Obstetrics and Gynecology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nuria Rodríguez
- Obstetrics and Gynecology Department, Hospital Universitari de la Vall d'Hebrón, Barcelona, Spain
| | - Oriol Porta
- Obstetrics and Gynecology Department, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eva Huguet
- Obstetrics and Gynecology Department, Hospital Universitari Mútua de Terrassa, Plaça Dr. Robert, 4, 08221, Terrassa, Spain
| | - Irene Mora
- Obstetrics and Gynecology Department, Consorci Sanitari d'Igualada, Igualada, Spain
| | - Marta Girvent
- Obstetrics and Gynecology Department, Hospital General de Granollers, Granollers, Spain
| | - Rebeca Fernández
- Obstetrics and Gynecology Department, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignasi Gich
- Sant Pau Biomedical Research Institute (IIB Sant Pau) and CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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Sarangapani A, Simpson AN, Snelgrove J, Higgins M, Windrim R, Satkunaratnam A. Video-Based Teaching in Patient and Instrument Selection for Operative Vaginal Deliveries. J Obstet Gynaecol Can 2018; 40:1162-1169.e3. [PMID: 30268313 DOI: 10.1016/j.jogc.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Worldwide, the rate of operative vaginal deliveries has decreased, and as a result trainees are lacking exposure and training. The aim of this study was to determine whether a video-based masterclass can improve trainees' confidence, comfort, and knowledge in performing second stage labour assessments and selecting appropriate patients and instruments for operative vaginal deliveries. METHODS Current University of Toronto obstetrics and gynaecology residents were invited to participate. The intervention included two videos on second stage assessment: (1) selecting the appropriate patient and (2) selecting the appropriate instrument for an operative vaginal delivery. Trainees' comfort and confidence were assessed pre- and post-intervention. A focus group was conducted that assessed trainees' knowledge acquisition. Descriptive thematic analysis was performed, and common themes were extracted. RESULTS On average, residents have performed more vacuum deliveries than forceps deliveries as primary operators (26.4 vs. 7.9). Following the video intervention, there was a statistically significant improvement (P ≤ 0.05) in trainees' comfort in the following areas: (1) understanding the maternal pelvis, (2) choosing instruments, (3) choosing forceps, (4) deciding the location of delivery, (5) identifying favourable clinical factors, and (6) identifying poor prognostic clinical factors. There was no difference in trainees' self-confidence. Major themes from focus group data included new knowledge gained on second stage assessment techniques, new approaches to existing knowledge, and the multiple challenges and barriers that exist to learning. CONCLUSION Video-based education on second stage labour assessment and operative vaginal delivery improves trainees' comfort and serves as a valuable complementary tool to clinical learning.
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Urbankova I, Grohregin K, Hanacek J, Krcmar M, Feyereisl J, Deprest J, Krofta L. The effect of the first vaginal birth on pelvic floor anatomy and dysfunction. Int Urogynecol J 2019; 30:1689-1696. [PMID: 31327032 PMCID: PMC6795623 DOI: 10.1007/s00192-019-04044-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/27/2019] [Indexed: 01/05/2023]
Abstract
Introduction and hypothesis First vaginal delivery severely interferes with pelvic floor anatomy and function. This study determines maternal and pregnancy-related risk factors for pelvic floor dysfunction (PFD), including urinary incontinence (UI), urgency, anal incontinence (AI), pelvic organ prolapse (POP) and levator ani muscle (LAM) avulsion. Methods This is a single-centre prospective observational cohort study on healthy women in their first singleton pregnancy. All underwent clinical and 3D transperineal ultrasound examination at 6 weeks and 12 months postpartum. Objective outcomes were POP-Q and presence or absence of LAM trauma. Functional outcomes were measured by the ICIQ-SF and PISQ 12. Multivariate regression was performed to determine birth and maternal habitus-related risk factors for UI, urgency, AI, dyspareunia, LAM avulsion and ballooning. Results Nine hundred eighty-seven women were included. Risk factors for UI were maternal age per year of age (OR: 1.09; 95% CI: 1.04–1.13; p = 0.0001) and BMI before pregnancy (OR: 1.08; 95% CI: 1.04–1.13; p = 0.001); for POP stage II+ maternal age (OR: 1.08; 95% CI: 1.08–1.14; p = 0.005). Avulsion was more likely after forceps (OR: 3.22; 95% CI:1.54–8.22; p = 0.015) but less likely after epidural analgesia (OR: 0.58; 95% CI: 0.37–0.90; p = 0.015) and grade I perineal rupture (OR: 0.50; 95% CI: 0.29–0.85; p = 0.012). Ballooning was more likely at increased maternal age (OR: 1.08; 95% CI: 1.02–1.13; p = 0.005), epidural (OR: 1.64; 95% CI: 1.06–2.55; p = 0.027) and grade I perineal rupture (OR: 1.79; 95% CI: 1.10–2.90; p = 0.018). Conclusion Though maternal characteristics at birth such as age or BMI increase the risk of PFD, labour and birth factors play a similarly important role. The most critical risk factor for MLA avulsion was forceps delivery, while an epidural had a protective effect. Electronic supplementary material The online version of this article (10.1007/s00192-019-04044-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iva Urbankova
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic.,Department of Development and Regeneration, Organ systems cluster, Group Biomedical Sciences, and Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Klara Grohregin
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic
| | - Jiri Hanacek
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic
| | - Michal Krcmar
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic
| | - Jaroslav Feyereisl
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic
| | - Jan Deprest
- Department of Development and Regeneration, Organ systems cluster, Group Biomedical Sciences, and Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Ladislav Krofta
- Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Podolske nabrezi 157, 14700, Prague, Czech Republic.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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O'Brien SM, Winter C, Burden CA, Boulvain M, Draycott TJ, Crofts JF. Pressure and traction on a model fetal head and neck associated with the use of forceps, Kiwi™ ventouse and the BD Odon Device™ in operative vaginal birth: a simulation study. BJOG 2019; 124 Suppl 4:19-25. [PMID: 28940875 PMCID: PMC7198111 DOI: 10.1111/1471-0528.14760] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
Objective To determine the pressure and traction forces exerted on a model fetal head by the BD
Odon Device, forceps and Kiwi ventouse during simulated births. Design Simulation study. Setting Simulated operative vaginal birth. Population or Sample 84 simulated operative vaginal births. Methods A bespoke fetal mannequin with pressure sensors around the head and strain gauge across
the neck was used to investigate pressure applied over the head, and traction across the
neck during 84 simulated births using the BD Odon Device, non-rotational forceps and
Kiwi ventouse. Main Outcome Measures Peak pressure on the fetal face and lateral aspects of the head during correct use of
the BD Odon Device and forceps. Peak pressure on orbits and neck during misplacement of
the BD Odon Device and forceps. Peak traction force generated until instrument failure
using the BD Odon Device, forceps and Kiwi ventouse. Results When correctly sited and using 80kPa inflation pressure on the cuff, the BD Odon Device
generated a lower peak pressure on the fetal head than forceps (83kPa vs 146kPa). When
instruments were purposefully misplaced over the orbits the BD Odon Device generated a
lower peak pressure on the orbits than forceps (70kPa vs 123kPa). When purposefully
misplaced over the neck the BD Odon Device, compared to forceps, generated a greater
peak pressure on the anterio-lateral aspect of the neck (56kPa vs 17kPa) and a lower
peak pressure on the posterior aspect of the neck (76kPa vs 93kPa) than forceps. In
cases of true cephalic disproportion the BD Odon Device ‘popped-off’ at a
lower traction force than forceps (208N vs 270N). Conclusions In simulated assisted vaginal birth with correctly placed instruments the peak pressure
exerted on the fetal head by a BD Odon Device is lower than pressure exerted by
non-rotational forceps. In cases in which delivery of the fetal head is not possible due
to cephalo-pelvic disproportion lower traction forces could be applied using the BD Odon
Device than with forceps before the procedure was abandoned due to device failure.
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Affiliation(s)
- S M O'Brien
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - C Winter
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK
| | - C A Burden
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - M Boulvain
- Department of Obstetrics & Gynaecology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - T J Draycott
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK.,School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - J F Crofts
- Department of Obstetrics & Gynaecology, Southmead Hospital, Bristol, UK
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Ferraz A, Nunes F, Resende C, Almeida MC, Taborda A. [Short-term neonatal outcomes of vacuum-assisted delivery. A case-control study]. An Pediatr (Barc) 2019; 91:378-385. [PMID: 30981643 DOI: 10.1016/j.anpedi.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The purpose of this study was to assess the neonatal morbidity and mortality associated with vacuum-assisted vaginal deliveries compared to all other vaginal deliveries, and to identify the associated risk factors. MATERIAL AND METHODS We conducted a retrospective case-control study in a level iii maternity hospital between 2012 and 2016, including 1,802 vacuum-assisted vaginal deliveries and 2control groups: 1802 spontaneous deliveries and 909 forceps-assisted deliveries. We considered minor complications (soft tissue trauma, cephalohaematoma, jaundice, intensive phototherapy, transient brachial plexus injury) and major complications (hypoxic-ischaemic encephalopathy, intracranial and subgaleal haemorrhage, seizures, cranial fracture, permanent brachial plexus injury), admission to the neonatal intensive care unit and death. RESULTS The risk of soft tissue trauma (aOR, 2.4; P<.001), cephalohaematoma (aOR, 5.5; P<.001), jaundice (aOR, 4.4; P<.001), intensive phototherapy (aOR, 2.1; P<.001) and transient brachial plexus injury (aOR; 2.1, P=.006) was higher in vacuum deliveries compared to spontaneous deliveries. Admission to the neonatal intensive care unit was also higher in vacuum deliveries compared to spontaneous deliveries (OR, 1.9; P=.001). When we compared vacuum with forceps deliveries, we found a higher risk of soft tissue trauma (OR, 2.1; P=.004), cephalohaematoma (OR, 2.2, P=.046) and jaundice (OR, 1.4; P=.012). Major complications were more frequent in the vacuum group comparing with the control groups, but the difference was not significant. The 2deaths occurred in vacuum deliveries (1.1 per 1000). CONCLUSION The proportion of minor neonatal complications was higher in the vacuum-assisted delivery group. Although major complications and death were also more frequent, they were uncommon, with no significant differences compared to the other groups. There are obstetrical indications for vacuum delivery, but it should alert to the need to watch for potential neonatal complications.
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Affiliation(s)
- Ana Ferraz
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Filipa Nunes
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Resende
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Céu Almeida
- Servicio de Obstetricia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Adelaide Taborda
- Servicio de Neonataologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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O'Brien S, Lenguerrand E, Jordan S, Cornthwaite K, Burden C, Timlin L, Siassakos D. Simulation TRaining for Operative vaginal Birth Evaluation: study protocol for an observational stepped-wedge interrupted time-series study (STROBE). BMC Pregnancy Childbirth 2019; 19:109. [PMID: 30940102 PMCID: PMC6444670 DOI: 10.1186/s12884-019-2222-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 02/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Operative vaginal birth is a common procedure used to expedite birth after full cervical dilatation where there is a clinical need to do so (15% of births in the UK in 2016). The acquisition of skills for operative vaginal birth is dependent on the exposure of junior obstetricians to situations in which they can undertake directly supervised learning from senior accouchers. The Royal College of Obstetricians and Gynaecologists has recently introduced the first structured course in operative vaginal birth. To date, there have been no attempts to determine the clinical impact of a structured training package for operative vaginal birth. Methods The STROBE study is a quasi-experimental before-after interrupted time-series study of the effect of simulation training in operative vaginal birth for obstetricians on clinical outcomes of women and babies following operative vaginal birth. Similar to a stepped-wedge design, the intervention will be gradually implemented in all participating units but at different time periods. The primary outcome is failed operative vaginal birth with the first intended instrument. Secondary maternal outcomes are; use of second instrument to achieve operative vaginal birth, caesarean section, episiotomy, perineal trauma (1st, 2nd, 3rd, 4th degree tear), cervical tear requiring suturing, general anaesthesia and estimated blood loss. Secondary neonatal outcomes are; Apgar score at one, five, and ten minutes, Umbilical artery pH, shoulder dystocia, admission to Neonatal Intensive Care Unit and death within 28 days of birth. The analysis will be intention-to-treat (per unit) on the primary and secondary outcomes. The STROBE study received approval from the Health Research Authority and is sponsored by North Bristol NHS Trust. Results will be published in an open-access peer-reviewed medical journal within one year of completion of data gathering. Discussion The STROBE study will help establish our understanding of the effectiveness of locally-delivered simulation training for operative vaginal birth. Robust evidence supporting the effectiveness of such an approach would add weight to the argument supporting regular, local training for junior obstetricians in operative vaginal birth. Trial registration ISRCTN11760611 05/03/2018 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12884-019-2222-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen O'Brien
- Translational Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. .,Women & Children's Directorate, North Bristol NHS Trust, Bristol, UK.
| | - Erik Lenguerrand
- Translational Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sharon Jordan
- Women & Children's Directorate, North Bristol NHS Trust, Bristol, UK
| | - Katie Cornthwaite
- Translational Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Women & Children's Directorate, North Bristol NHS Trust, Bristol, UK
| | - Christy Burden
- Translational Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Women & Children's Directorate, North Bristol NHS Trust, Bristol, UK
| | - Laura Timlin
- Research & Innovation, North Bristol NHS Trust, Bristol, UK
| | - Dimitrios Siassakos
- Translational Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,Women & Children's Directorate, North Bristol NHS Trust, Bristol, UK
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O’Brien S, Hotton EJ, Lenguerrand E, Wade J, Winter C, Draycott TJ, Crofts JF. The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study. Trials 2019; 20:159. [PMID: 30836979 PMCID: PMC6402154 DOI: 10.1186/s13063-019-3249-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Assisted vaginal birth is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for assisted vaginal birth (forceps and ventouse) are often not utilised in settings where there is most clinical need, resulting in maternal and neonatal morbidity and mortality which could have been prevented. The BD Odon Device is a new device for assisted vaginal birth that may be able to address this unmet need. However, before dissemination, the device requires evaluation in robust clinical trials. A feasibility study to investigate the clinical impact, safety, and acceptability of the BD Odon Device for assisted vaginal birth is therefore planned. This will provide further information on acceptability, recruitment, and the outcome data required to design a future randomised controlled trial of the BD Odon Device versus Kiwi ventouse. METHODS Forty women who require an assisted vaginal birth for a recognised clinical indication will have the birth assisted with the BD Odon Device. The primary outcome is successful vaginal birth completed with the BD Odon Device. Secondary clinical outcomes include maternal and neonatal outcomes, and maternal and practitioner satisfaction. Safety data will be reviewed following every birth. DISCUSSION A future randomised controlled trial of the BD Odon Device versus the current standard instrument (the Kiwi ventouse) is planned. The findings of the ASSIST Study will inform the randomised controlled trial design. TRIAL REGISTRATION ISRCTN, ISRCTN10203171 . Prospectively registered on 27 July 2018.
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Affiliation(s)
- Stephen O’Brien
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Emily J. Hotton
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Erik Lenguerrand
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cathy Winter
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Tim J. Draycott
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
| | - Joanna F. Crofts
- Women & Children’s Directorate, North Bristol NHS Trust, Bristol, BS10 5NB UK
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Caudwell-Hall J, Weishaupt J, Dietz HP. Contributing factors in forceps associated pelvic floor trauma. Int Urogynecol J 2020; 31:167-71. [PMID: 30666429 DOI: 10.1007/s00192-019-03869-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/02/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Levator avulsion occurs in 10-35% of women after a first vaginal delivery, with forceps being the main risk factor. Three mechanisms have been proposed to account for the high risk of trauma: the additional space requirement, increased speed of distension, and/ or greater force. This study examines the additional space requirements associated with forceps to determine any associated increase in avulsion risk. METHODS This was an in vitro simulation study of spatial requirements for delivery of a fetal head by forceps, with mathematical modelling of spatial requirements using data from a local observational study. A balloon device was used to model head circumferences through the range of expected measurements at term, with measurements taken after application of three different types of forceps. Each measurement was performed in triplicate. RESULTS On average, forceps increased the circumference of the fetal head by 1.01 cm for Wrigley's, 1.04 cm for Kielland's, and 1.64 cm for Neville-Barnes forceps, resulting in an estimated increase in the diameter of the fetal head by 0.32 cm, 0.33 cm, and 0.52 cm, respectively. This increase was linear throughout the tested range. In 534 singleton pregnancies at term, we determined an odds ratio (OR) of 1.11 per centimeter head circumference for avulsion. Hence, the additional space requirement due to forceps explains ORs of 1.11, 1.12, and 1.19 for avulsion, depending on forceps type. CONCLUSIONS The effect of forceps on avulsion risk is not fully explained by the increase in space requirement alone. Other factors, such as shortened time to maximum distension and/or increased peak force applied may contribute to the excess risk.
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Friedman T, Eslick GD, Dietz HP. Delivery mode and the risk of levator muscle avulsion: a meta-analysis. Int Urogynecol J 2019; 30:901-7. [PMID: 30649566 DOI: 10.1007/s00192-018-3827-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Female pelvic organ prolapse (POP) is a common condition, with a lifetime risk for surgery of 10-20%. Pregnancy and childbirth are the commonest modifiable risk factors for POP, and avulsion of the levator ani muscle is likely to be an etiological factor. Avulsion is more common in instrumental delivery. However, we were unable to identify a meta-analysis on this issue. Our aim was to perform a systemic review and quantitative meta-analysis of the prevalence of avulsion relative to delivery mode. METHODS Four electronic databases (MEDLINE, PubMed, Embase, and Google Scholar) were searched for studies published between 1991 and 1 October 2018 without language restrictions. RESULTS Twenty studies met inclusion criteria, and 14 were prospective. Seventeen used sonographic techniques; three were magnetic resonance (MR) studies. For this review, three comparisons were performed: forceps vs. vacuum (9 studies), forceps vs. normal vaginal delivery (NVD) (12 studies), and vacuum vs. NVD (12 studies). The first meta-analysis showed an increased risk for avulsion following forceps compared with vacuum, with an odds ratio (OR) of 4.57 and confidence interval (CI) 3.21-6.51, p < 0.001. The second showed an increased risk for avulsion following forceps compared with NVD, with an OR of 6.94 (4.93-9.78), p < 0.001. The third showed no significant increased risk for avulsion following vacuum compared with NVD, with an OR of 1.31 (1.00-1.72), p = 0.051. CONCLUSIONS Forceps is a strong risk factor for avulsion, with an OR of 6.94 (4.93-9.78) compared with NVD and an OR of 4.57 (3.21-6.51) compared with vacuum birth.
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Foerster B, Shariat SF, Klein JT, Bolenz C. [Biopsy techniques in the upper urinary tract for the diagnosis of urothelial carcinoma: systematic review]. Urologe A 2019; 58:14-21. [PMID: 30617531 DOI: 10.1007/s00120-018-0829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The diagnostic accuracy of ureteroscopic biopsies in the upper urinary tract is limited by technical difficulties during extraction and small sample size. OBJECTIVES To evaluate the impact of different techniques and instruments on the histopathologic quality and diagnostic yield of extracted samples as well as the predictive value of clinical grading and staging on final pathologic stage at radical nephroureterectomy. MATERIALS AND METHODS For this systematic review, we searched PubMed and Embase databases for original publications and meeting abstracts according to the PRISMA guidelines. RESULTS Overall, we included 23 studies which comprised a total of 1547 biopsies for the investigation of diagnostic yield and 778 patients for the assessment of grade and stage concordance. We found that the median diagnostic yields of big retrograde 2F [french] forceps, antegrade 3F forceps and baskets in combination with forceps were 92% (range 83-100), 72% (50-90) and 91% (78-94), respectively. Median rates of grade concordance and upgrading across all techniques ranged between 78-89% and 5-16%, respectively, without relevant differences. CONCLUSIONS The choice of biopsy technique affects the ability to diagnose upper tract urothelial carcinoma. The correct determination of pathologic grading is comparable between different techniques. The combination of biopsy forceps and baskets during ureterorenoscopy seems to achieve optimal diagnostic accuracy.
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Rasteau S, Sigaux N. [About history of surgeons hidden behind our daily surgical instruments: Forceps]. ANN CHIR PLAST ESTH 2019; 64:144-9. [PMID: 30606620 DOI: 10.1016/j.anplas.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 11/20/2022]
Abstract
Many surgical instruments are named after their inventors, acclaimed surgeons of the past, because of their discoveries and their contributions in the field of surgical techniques. However, these daily reminders of History of Surgery are often forgotten by the modern practitioners. We propose to review, through a selection of instruments, short biographies of these precursors. This first original article will focus on the inventors of modern forceps: Debakey, Adson, Kocher, Péan, Tuffier and Halsted.
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Wu H, Yue J. Effects of maternal obesity on the success of assisted vaginal delivery in Chinese women. BMC Pregnancy Childbirth 2018; 18:509. [PMID: 30591024 PMCID: PMC6307111 DOI: 10.1186/s12884-018-2151-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022] Open
Abstract
Background We examined the influence of pre-pregnancy body weight on the rates of attempted and successfully assisted-vaginal delivery. Methods We used 2008–2016 inpatient records including 3408 women who had singleton gestations and needed operative delivery assistance to conduct a retrospective cohort study. Patients were categorized based on pre-pregnancy BMI (normal weight = 18.5 to less than 25 or obese = 30 or greater). We used logistic regression to estimate odds ratios and 95% confidence intervals of attempted and successful forceps or vacuum-assisted vaginal delivery by body weight adjusted for marital status, age, gestational age, induction of labor, episiotomy, diabetes, and birth weight. Results The proportion of women with attempted either vacuum or forceps was lower among women who were obese pre-pregnancy compared to women who were normal weight. Women with excessive gestational weight gain, large for gestational age neonates, and diabetes were less likely to have a vacuum-assisted or forceps-assisted vaginal delivery attempted. Conversely, women who received labor augmentation or induction, used epidural anesthesia, gained inadequate weight, and delivered a small for gestational age infant were more likely to have a vacuum-assisted or forceps-assisted vaginal delivery attempted. Compared to normal weight women, obese women who received forceps-assisted vaginal delivery were more likely to have a successful vaginal delivery. Conclusion Women who had normal weight had higher likelihood to attempt assisted vaginal delivery compared to women who had pre-pregnancy obesity. However, when assisted vaginal delivery was attempted, success rates were higher when forceps-assisted delivery was used compared to vacuum-assisted delivery.
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Affiliation(s)
- Hongying Wu
- Department of Gynaecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, People's Republic of China
| | - Jiayi Yue
- Department of Gynaecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, 252000, Shandong Province, People's Republic of China.
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Almadani A, Ping MNY, Deenadayalu A, Saunders J, O'Brien A. The Effect of Using Different Types of Forceps in the Efficacy of Transbronchial Lung Biopsy. Lung 2018; 197:61-66. [PMID: 30443800 DOI: 10.1007/s00408-018-0179-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Transbronchial lung biopsy (TBBX) is a common respiratory diagnostic procedure performed to investigate several lung diseases. There are different types of forceps used to perform this procedure. The alligator and cupped (oval) forceps are most commonly used ones. To date, there are few studies that have compared the efficacy of these two types of forceps. This study compares the two types of forceps relating to the rate of complications and diagnostic value. METHODS In this retrospective observational study, 40 patients who underwent TBBX using the alligator forceps were compared to a previous group of 40 patients who underwent the same procedure using the cupped forceps. The two groups were compared with respect to the rate of complications (bleeding and pneumothorax), diagnostic value and size of biopsies. RESULTS The rate of complications was higher in patients who underwent TBBX using alligator forceps, in which seven patients (17.5%) had significant bleeding in the group that used alligator forceps versus three patients (7.5%) in cupped forceps group. Pneumothorax developed in three patients, all of whom were in the alligator forceps group. While there was no significant difference in the adequacy and size of the samples, the diagnostic yield was higher in the cupped forceps group. CONCLUSIONS The results of the study showed that using cupped forceps in performing TBBX had fewer complications (pneumothorax and bleeding) and a higher diagnostic yield in comparison with alligator forceps, but the difference did not reach a statistical significant value.
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Affiliation(s)
- Abdulrahman Almadani
- University Hospital Limerick, Limerick, Ireland. .,Bahrain Defence Force Hospital-Royal Medical Services (BDF-RMS), Riffa, Bahrain.
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Höntzsch D, Oh CW, Fernandez A, Regazzoni P. [Special reduction instruments]. Unfallchirurg 2019; 122:120-6. [PMID: 30306213 DOI: 10.1007/s00113-018-0562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Special and specialized instruments help perform reduction more effectively and in a tissue-preserving manner. In addition to other articles, the application and advantages of the following instruments are presented: colinear reduction forceps, cerclage, cerclage passer, distal radius reduction clamp, modular external fixator, extension table, distraction frame, joystick, manipulators, distractor and assistance of reduction with elastic nails.
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Vannevel V, Swanepoel C, Pattinson RC. Global perspectives on operative vaginal deliveries. Best Pract Res Clin Obstet Gynaecol 2018; 56:107-113. [PMID: 30392949 DOI: 10.1016/j.bpobgyn.2018.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/25/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
Operative vaginal delivery (OVD) refers to the use of an instrument (forceps or vacuum device) to assist with the delivery of the fetus from the vagina. This can help improve maternal and fetal outcomes and has to be weighed up against the risks and benefits of performing second-stage cesarean deliveries. OVD forms an integral part of basic emergency obstetric care and a skilled birth attendant's duties. Outlet forceps and vacuum extraction should be used to shorten the second stage of labor and to improve maternal and fetal outcomes associated with delayed second stage. Despite the known benefit of OVD, available data on the use of OVDs in low- and middle-income countries show very low rates, mostly due to the lack of skilled healthcare workers and equipment shortages. Increased use of OVD can safely reduce the number of second-stage cesarean deliveries with its associated morbidity and mortality. We recommend implementing training programs to increase the number of skilled healthcare workers and strengthening health systems to provide birthing facilities with the equipment required to perform OVD.
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Affiliation(s)
- V Vannevel
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa.
| | - C Swanepoel
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa
| | - R C Pattinson
- South African Medical Research Council, Maternal and Infant Health Strategies Unit, Department of Obstetrics and Gynaecology, University of Pretoria, South Africa
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Zhao Y, Zou L, Xiao M, Tang W, Niu HY, Qiao FY. Effect of different delivery modes on the short-term strength of the pelvic floor muscle in Chinese primipara. BMC Pregnancy Childbirth 2018; 18:275. [PMID: 29970030 PMCID: PMC6029267 DOI: 10.1186/s12884-018-1918-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effect of different delivery modes and related obstetric factors on the short-term strength of the pelvic floor muscle after delivery in Chinese primipara. METHODS A total of 4769 healthy Chinese primiparas at postpartum 6-8 weeks were interviewed. According to the difference of delivery mode, the selected primiparas were divided into 2 groups, including cesarean delivery group containing 2020 and vaginal delivery group containing 2749. All the vaginal deliveries were further divided into 3 groups, including episiotomy group containing 2279, perineal laceration group containing 398, and forceps assisted group containing72. The scales of their pelvic floor muscle (PFM) strengths were examined by specially trained personnel using digital palpation (Modified Oxford scale:0-5 grade). According to participants' willingness, if the PFM strength was weak (0 or 1 grade), at-home PFM training would be recommended and an electrical stimulation combined with biofeedback therapy would be conducted for them in hospital. Twelve weeks after delivery, the PFM strength would be measured again. For statistical analysis, t-test, one-way variance analysis, Chi-square analysis, Kruskal-Wallis test H, Mann-Whitney U test and Wilcoxon test were carried out. RESULTS The PFM strength in cesarean delivery group was higher than in vaginal delivery group (p < 0.05). Among 3 vaginal delivery groups, the PFM strength in perineal laceration group was the highest (p < 0.05); however, there was no difference in PFM strength between episiotomy group and forceps assisted group (p>0.05). After accepting PFM training at home and therapy in hospital, 305 women showed increased PFM strength (p < 0.05). CONCLUSIONS Vaginal delivery is an independent risk factor causing the damage of PFM, and episiotomy may cause injury of PFM. Through PFM training at home and therapy in hospital, those damage will resume as soon as possible in the short-time period after delivery.
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Affiliation(s)
- Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, No 745 Wuluo Road, Wuhan City, People's Republic of China
| | - Li Zou
- Department of Obstetrics and Gynecology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, People's Republic of China
| | - Mei Xiao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, No 745 Wuluo Road, Wuhan City, People's Republic of China.
| | - Wan Tang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, No 745 Wuluo Road, Wuhan City, People's Republic of China
| | - Hai-Yi Niu
- Department of Obstetrics and Gynecology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, People's Republic of China
| | - Fu-Yuan Qiao
- Department of Obstetrics and Gynecology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, People's Republic of China
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Yoo IK, Choi HS, Chun HJ, Kim SH, Lee JM, Kim ES, Keum B, Lee HS, Jeen YT, Kim CD. A promising Forcep Strip Method for gastrointestinal subepithelial tumors originating from the muscularis propria. Dig Liver Dis 2018; 50:360-365. [PMID: 29398415 DOI: 10.1016/j.dld.2017.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/06/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subepithelial tumors (SETs) originating from the muscularis propria layer are unlikely to be resected completely and safely. We developed the Forcep Strip Method (FSM) for the resection of SETs in the stomach. AIMS This study aimed to evaluate the feasibility and safety of the FSM. METHODS Endoscopic SET resection using electrical forceps was performed in 11 consecutive patients with clinical indications for lesion removal. Following injection around the tumor, the adjacent mucosa or submucosa was grasped with the hot forceps and pulled away to form a "tent". The tumor was dissected from the muscularis propria layer and carefully removed using coagulating forceps. RESULTS The FSM was successful in 10 of the 11 patients in the series; one patient required surgery due to respiratory depression during the procedure. The complete resection rate was 100% and no major complications including bleeding and perforation occurred. Mean procedure time was 39.3 ± 14.7 min, mean hospitalization time was 5.0 ± 1.2 days, and mean tumor size was 17.1 ± 4.7 mm. CONCLUSION FSM was found to be an easy, safe, and effective procedure for the treatment of gastric SETs originating from the muscularis propria layer.
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Affiliation(s)
- In Kyung Yoo
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea.
| | - Seung Han Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Republic of Korea
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Fritel X, Gachon B, Desseauve D, Thubert T. [Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention]. ACTA ACUST UNITED AC 2018; 46:419-26. [PMID: 29500142 DOI: 10.1016/j.gofs.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Sawabata N, Hyakutaka T, Kawaguchi T, Yasukawa M, Kawai N, Tojo T, Taniguchi S. A no-touch technique for pulmonary wedge resection of lung cancer. Gen Thorac Cardiovasc Surg 2017; 66:161-167. [PMID: 29128899 DOI: 10.1007/s11748-017-0863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/07/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Many of the surgical patients with lung cancer die by metastasis originated from circulating tumor cells (CTCs) which are seeds of metastases. A ring-shaped catching forceps, which generates the great pressure by compression, may reduce the risk of tumor cell spreading. Here, we investigated the efficacy of such forceps based on CTC occurrence. METHODS Twenty-three patients with clinical stage IA lung cancer who underwent a pulmonary wedge resection were investigated in a clinical-pathological manner. They were divided into those treated using ring forceps catching without tumor release (R group) (n = 16) and non-complete use of ring forceps (N group) (n = 7), then were determined circulating tumor cells (CTCs). RESULTS Radiographic findings, tumor location, pathological diagnosis, and stapling method were not significantly different between the groups. The risk of detection of CTCs after surgery was significantly lower in group R (12.5 vs. 85.7%, p = 0.02), whereas there were no significant differences found in risk of negative-stapled margin cytology, pre-OP CTC detection, V (+), Ly (+), and Pl (+). CONCLUSIONS Patients who underwent pulmonary wedge resection of lung cancer had low chance of CTC detection after surgery when they were treated with ring forceps without tumor release, which might become a no-touch isolation technique.
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Affiliation(s)
- Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan.
- Division of General Thoracic Surgery, Hoshigaoka Medical Center, Hirakata, Japan.
| | - Takeru Hyakutaka
- Division of General Thoracic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan
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Boos J, Yoo RJ, Steinkeler J, Ayata G, Ahmed M, Sarwar A, Weinstein J, Faintuch S, Brook OR. Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction. Eur Radiol 2018; 28:522-9. [PMID: 28779396 DOI: 10.1007/s00330-017-4987-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction. METHODS A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated. RESULTS A total of 232 interventions in 129 patients (70.8 ± 11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6-48.7%), 42.7% (32.4-53.0%) and 55.8% (44.7-66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96. CONCLUSION Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction. KEY POINTS • Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy. • Brush cytology may help to overcome "crush artefacts" from forceps biopsy. • The cost per diagnosed malignancy may warrant tandem procedure in all patients.
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McClelland S, Gorfinkle N, Arslan AA, Benedetto-Anzai MT, Cheon T, Anzai Y. Factors associated with cesarean delivery rates: a single-institution experience. Matern Health Neonatol Perinatol 2017; 3:8. [PMID: 28439421 PMCID: PMC5401466 DOI: 10.1186/s40748-017-0047-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to identify factors associated with variability in Cesarean delivery (CD) rates amongst providers at a single institution. METHODS A retrospective cohort analysis was carried out on all births at NYU Langone Medical Center from 2005-2013. Data was collected for subjects and linked to diagnosis codes for singleton and twin deliveries. Descriptive characteristics were generated for all deliveries, and inferential analysis was performed including multiple covariates for singleton deliveries in the 2010-2013 cohort, including both univariate and multivariate regression analyses to identify factors associated with higher CD rates. RESULTS 37,692 deliveries were identified at our institution during the study period, performed by 88 unique providers. The mean CD rate was 29.6%, with a range for individual physicians from 9.9% to 75.6%. In multivariate regression analysis, CD rate was directly correlated with average patient age, physician male gender, proportion of high-risk deliveries, and Maternal-Fetal Medicine specialty, and it was inversely correlated with total number of deliveries by physician and forceps delivery rate. There was no significant difference in CD rates between group and solo practices. Within the same group practice, each member's CD rate was strongly correlated with the average CD rate of the group. CONCLUSION Our study demonstrates the wide range of CD rates for providers practicing within the same institution and reiterates the association of CD rates with patient age, high-risk pregnancy, and provider volume. Among operative vaginal deliveries, forceps delivery rate was associated with lower CD rates whereas vacuum delivery rate was not. Despite these findings, practice patterns within individual practices appear to contribute significantly to the wide range of CD rates.
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Affiliation(s)
- Spencer McClelland
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Naomi Gorfinkle
- Johns Hopkins University School of Medicine, 4 South Broadway, Baltimore, MD 21231 USA
| | - Alan A. Arslan
- NYU Langone Medical Center, Division of Epidemiology, Departments of Obstetrics and Gynecology, Environmental Medicine, and Population Health, 650 First Ave, Rm. 532, New York, NY 10016 USA
| | - Maria Teresa Benedetto-Anzai
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Teresa Cheon
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
| | - Yuzuru Anzai
- NYU Langone Medical Center, Department of Obstetrics and Gynecology, 800 2nd Avenue, Suite 815, New York, NY 10017 USA
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Crosby DA, Sarangapani A, Simpson A, Windrim R, Satkunaratnam A, Higgins MF. An international assessment of trainee experience, confidence, and comfort in operative vaginal delivery. Ir J Med Sci 2017; 186:715-21. [PMID: 28271279 DOI: 10.1007/s11845-017-1593-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
AIM The aim of this study was to assess Irish and Canadian obstetricians in training ("trainees") experience, confidence, and comfort in performing operative vaginal delivery (OVD). STUDY DESIGN Trainees in Obstetrics and Gynaecology in the University of Toronto and the Royal College of Physicians of Ireland (RCPI) were invited to participate in an anonymous online survey reviewing experience as primary operator of OVD. Trainee confidence and comfort was self-assessed based upon their last few OVDs. RESULTS The response rate was 55% amongst Canadian trainees (31/56) and 44% amongst Irish trainees (21/48). When comparing Irish with Canadian trainee experience, the median numbers of vacuum and forceps deliveries performed by Irish trainees as primary operator were reported to be higher [125 (range 10-150) vs 20 (range 5-40); p < 0.0001 (ventouse), 45 (range 10-150) vs 6 (range 1-12); p = 0.0001 (forceps)]. Despite this, trainee confidence between the groups did not differ [confidence score: 18.7 (SD 3.2) vs 17.8 (SD 3.5), p = 0.3]. There were some differences regarding comfort in certain aspects of OVD, most notably increased comfort in Irish trainees in pre-procedure assessment skills of OVD. CONCLUSION With falling OVD rates worldwide, training experience is declining. Despite higher numbers of OVD within the Irish trainee group, there was no difference in trainee confidence between the two groups. These results suggest that a high number of cases as primary operator may not be required to establish operator confidence in performing a procedure. Irish trainees self-reported more comfort in non-technical skills of OVD, suggesting a step-wise effect of experience on first technical and then non-technical skills.
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Xu XL, Gong YM, Zhang Y, Li HJ, Liu CQ. Endoscopic nylon rope trapping with forceps pulling for removal of long hard foreign bodies in the upper gastrointestinal tract. Shijie Huaren Xiaohua Zazhi 2017; 25:531-535. [DOI: 10.11569/wcjd.v25.i6.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy and safety of endoscopic nylon rope trapping with forceps pulling for removal of long hard foreign bodies in the upper gastrointestinal tract.
METHODS Fifteen patients with long hard foreign bodies in the upper gastrointestinal tract were divided into either a control group (n = 5) or a study group (n = 10). In the control group, foreign bodies were removed by snare. In the experimental group, foreign bodies were removed by endoscopic nylon rope trapping with forceps pulling.
RESULTS In the control group, all foreign bodies were in the stomach. Cardiac bleeding occurred in one case during the removal of the foreign body, and hemostasis was achieved by spraying diluted epinephrine solution. Blood oozing in different parts of the esophagus was caused in all the five cases but did not require special treatment. In the study group, gastric foreign bodies were successfully removed in all the ten cases, of which eight had no cardiac or esophageal injury and two had mild blood oozing in different parts of the esophagus but did not require special treatment.
CONCLUSION Endoscopic nylon rope trapping with forceps pulling is safe and reliable in the removal of long hard foreign bodies in the upper gastrointestinal tract.
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Endoh M, Oizumi H, Kanauchi N, Kato H, Ota H, Suzuki J, Watarai H, Nakamura M, Sadahiro M. Removal of foreign bodies from the respiratory tract of young children: Treatment outcomes using newly developed foreign-body grasping forceps. J Pediatr Surg 2016; 51:1375-9. [PMID: 27001457 DOI: 10.1016/j.jpedsurg.2016.02.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although a foreign body in the airway of children constitutes a medical emergency, most available therapeutic tools are insufficient, and treatment can be difficult. Herein, we evaluated the outcomes of various treatment methods of foreign body removal from the respiratory tract. METHODS We retrospectively analyzed 24 children (13 boys, 11 girls; median age, 18months [range, 9-60months]) treated for airway foreign bodies from January 1994 to December 2013 by examining their preoperative diagnoses and anesthesia and surgical methods. RESULTS The foreign body was a peanut, green soybean, almond, chestnut, dental prosthesis, and bead in 15, 3, 3, 1, 1, and 1 cases, respectively. General anesthesia was used in all cases, and flexible bronchoscopy was performed under airway maintenance using a laryngeal mask in 23 cases. The mean operation time was 51±32min. Grasping forceps, basket forceps, and a Fogarty catheter were used in 14, 7, and 2 cases, respectively. In July 2003, 3-pronged foreign-body grasping forceps with a 2.0-mm diameter designed for use with a thin bronchoscope were introduced. Of 16 treated cases, 9 were successfully treated with only forceps. The mean operation time was significantly shortened to 38±24min (range, 7-91min) compared to the traditional operation time of 82±42min (range, 23-147min) (p=0.01). CONCLUSIONS These novel forceps are useful for reducing the operation time and are suitable for removing airway foreign bodies from children with a narrow tracheobronchial caliber.
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Sussman DA, Deshpande AR, Shankar U, Barkin JA, Medina AM, Poppiti RJ, Cubeddu LX, Barkin JS. Comparison of Performance Characteristics of Oval Cup Forceps Versus Serrated Jaw Forceps in Gastric Biopsy. Dig Dis Sci 2016; 61:2338-43. [PMID: 27003145 DOI: 10.1007/s10620-016-4129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/10/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Obtaining quality endoscopic biopsy specimens is vital in making successful histological diagnoses. The influence of forceps cup shape and size on quality of biopsy specimens is unclear. AIM To identify whether oval cup or two different serrated jaw biopsy forceps could obtain specimens of superior size. Secondary endpoints were tissue adequacy, depth of tissue acquisition, and crush artifact. METHODS A single-center, prospective, pathologist-masked, randomized controlled trial was performed. In total 136 patients with a clinical indication for esophagogastroduodenoscopy with biopsy were randomized to receive serial biopsies with a large-capacity serrated forceps with jaw diameter 2.2 mm (SER1) and either a large-capacity oval forceps with jaw diameter 2.4 mm (OVL) or large-capacity serrated biopsy forceps with jaw diameter 2.4 mm (SER2) in two parallel groups. RESULTS SER2 provided significantly larger specimens than did the other forceps (SER2 3.26 ± 1.09 vs. SER1 2.92 ± 0.88 vs. OVL 2.92 ± 0.76; p = 0.026), with an average size difference of 0.34 mm greater with SER2 compared to SER1 and OVL. OVL provided significantly deeper biopsies compared to SER1 and SER2 (p = 0.02), with 31 % of OVL biopsies reaching the submucosa. SER2 had significantly less crush artifact than SER1 and OVL (p < 0.0001). CONCLUSION Serrated forceps provided larger samples compared to oval jaw forceps of the same size, with SER2 providing the largest specimen size. Oval cup forceps had deeper penetration of epithelium, while the larger jaw diameter serrated jaw forceps had less crush artifact. All three forceps provided specimens adequate for diagnostic purposes.
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