Forceps Delivery Research Articles

Labor and delivery outcomes by delivery method in term deliveries in occiput posterior position: a population-based retrospective cohort study

Occiput posterior is the most common malposition in labor. Deliveries in occiput posterior position have been shown to have higher rates of adverse short-term maternal and neonatal outcomes compared with deliveries in occiput anterior position. There are no guidelines providing recommendations nor summarizing risks of adverse outcomes by delivery method to inform the decision-making process in occiput posterior delivery management. Population-based studies examining the outcomes associated with various management processes of occiput posterior position at the time of labor or delivery are lacking. This study aimed to describe the current management of term singleton occiput posterior deliveries in British Columbia, Canada and to examine the association between different management strategies and adverse outcomes by describing the rates of: occiput posterior malposition; and spontaneous vaginal delivery, operative vaginal delivery, and cesarean delivery from occiput posterior malposition. We also analyzed the rates of adverse labor and delivery outcomes stratified by fetal position and delivery mode, and the interaction effect of occiput posterior position and delivery mode on the rates of adverse outcomes. This was a retrospective cohort study of cephalic term singleton deliveries in British Columbia from 2004 to 2020, using the British Columbia Perinatal Data Registry. The obstetrical adverse outcome index (a composite of 10 adverse maternal or neonatal events), adverse outcome index subcomponent rates, and adverse outcome index-derived weighted scores were compared between deliveries stratified by fetal position at delivery (occiput posterior or occiput anterior) and occiput posterior deliveries stratified by delivery method. Multivariable log-binomial logistic regression was used to model the adverse outcome index score. Of 306,237 term births, 19% had occiput posterior position during labor, 37% of which persisted in occiput posterior position at delivery. Among occiput posterior deliveries, 27% were spontaneous vaginal deliveries, 8% vacuum, 5% forceps, 1% mixed vacuum-forceps, and 59% were cesarean delivery; this distribution differed from that of occiput anterior deliveries (P<.0001). Overall, adverse outcome index scores were significantly higher in persistent occiput posterior deliveries (8.8% had ≥1 adverse outcomes; adjusted rate ratio, 1.07 [1.01-1.14]) than in occiput posterior labors that rotated to occiput anterior deliveries; the most frequent adverse outcome was third- or fourth-degree lacerations. Neonatal adverse outcomes were also more frequent in occiput posterior delivery (4.3% vs 3.3%; adjusted rate ratio, 1.21 [1.10-1.35]), whereas maternal outcomes were similar between groups (4.8% vs 6.0%; adjusted rate ratio, 1.04 [0.96-1.13]). Among persistent occiput posterior deliveries, spontaneous vaginal delivery and cesarean delivery had the lowest proportion of deliveries with ≥1 adverse outcomes (6.1% and 6.2%), whereas forceps deliveries had the highest (38.1%); the largest contributor to the adverse outcomes were third- or fourth-degree lacerations. Among occiput posterior deliveries with any adverse outcome, cesarean delivery had the highest Severity Index score, due in part to the inclusion of third- or fourth-degree tears (which are assigned a comparatively low score) as the most common adverse event in the other vaginal delivery modes, and because of outcomes with a higher severity score being associated with cesarean delivery, such as uterine rupture (a reason for cesarean delivery) and intensive care unit admission (an outcome following cesarean delivery). Overall, in a multivariable regression model, delivery mode and the interaction between delivery mode and occiput posterior position were significant predictors of a delivery with ≥1 adverse outcomes, whereas occiput posterior position itself was not. One in five singleton deliveries at term gestation had occiput posterior position in labor; most of these rotated to occiput anterior by delivery, which had better outcomes than persistent occiput posterior deliveries. Among the latter, spontaneous vaginal delivery and cesarean delivery had the lowest frequency of adverse outcomes, whereas forceps deliveries had the highest. This study provides a robust updated analysis of birth outcomes following different occiput posterior management strategies, which can inform provider decision-making and counseling. Its observational design may limit its use for direct recommendations for management of occiput posterior malposition, yet the study helps to define the risks associated with different modes of delivery in the setting of occiput posterior malposition. With additional studies examining success rates of intermediate occiput posterior-occiput anterior rotation, other delivery management steps, and long-term outcomes, this study helps to define safe management of occiput posterior delivery.

Mitigating the stress of transition: An exploration of the effects and effectiveness of a preparatory course for junior obstetric trainees transitioning to senior training roles

BackgroundAttrition amongst obstetrics trainees is high worldwide and attributed to sources of stress and burnout. The role of formal education and simulation as a means to prepare trainees for stressful periods such as transition into senior roles is underexplored. ObjectiveThis study set out to explore whether the creation of a dedicated educational intervention might positively influence burnout and self-estimated preparedness for practice among obstetric trainees transitioning into more senior roles. Study designA six-week preparatory training programme for year 2 trainees was created specifically for this study. The intervention used the flipped classroom design incorporating online learning that prepared participants for six simulation-based workshops. Participants were randomised by training cluster into an intervention group (n = 4) who participated in the educational intervention and a control group (n = 7) who received standard online and workplace training. The effects on trainee well-being was assessed using the Maslach burnout inventory (MBI) and a self-report questionnaire estimating preparedness for practice. Technical and non-technical skills were assessed using standardised OSAT and NOTSS assessment tools. The primary outcomes were MBI and preparedness for practice scores. Secondary outcomes included OSAT and NOTSS scores. Group comparisons were made using by t-test or Pearson Chi2 analysis where appropriate. ResultsThe study indicated a positive, non-significant trend in pre-post burnout scores in the intervention group. The following improving trends were noted in all subscales: emotional exhaustion 21.5 ± 2.6 (pre-intervention 23 ± 6.2); depersonalisation 9.8 ± 4.0 (pre-intervention 12.3 ± 2.8); personal accomplishment 35.5 ± 6.51 (pre-intervention 33 ± 5.5). The educational intervention engendered an increase in self estimated preparedness for practice amongst the intervention group (p = 0.006). From a training perspective, increased preparedness was noted for the following practical skills: forceps delivery (p = 0.0001), rotational forceps delivery (p = 0.02), delivery of twins vaginally (p = 0.0007) and performing a pudendal block (p = 0.001). ConclusionThis is one of the first studies to investigate whether the provision of a targeted training module can improve burnout scores and preparedness for practice amongst obstetrics trainees at an important time of transition. The positive but largely non-significant findings of this study should be examined in larger longitudinal and adequately powered studies.

Nestor Maksimovich-Ambodik»s contribution to the art of healing

Nestor Maksimovich Maksimovich-Ambodik is considered one of the founders of obstetrics, it was he who came up with the idea of using obstetric forceps. Maksimovich-Ambodik was the first to prepare and publish the well-known treatise "The Art of Midwifery, or the Science of Women's Business". More than one generation of students studied according to his textbooks. It is noteworthy that he was the first to start teaching at a medical university in Russian; before that, all lectures were given in Latin. However, few people know that this scientist was also seriously involved in the issues of herbal medicine. In 1784, the scientist published the book "Encyclopedia of Nutrition and Healing, compiled by the personal physician of Her Imperial Majesty Catherine II in 1784, professor N. Ambodik", which is the richest collection of descriptions of medicinal plants. In his medical practice, this scientist and doctor gave preference to medicinal herbs, believing that the more complete the unity of an individual with nature is, the faster s/he will be able to achieve harmony and defeat the disease. Thus, Nestor Maksimovich-Ambodik can rightfully be considered the founder of not only obstetrics, but also herbal medicine.

Risk factors for severe perineal lacerations during childbirth: A systematic review and meta-analysis of cohort studies.

To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations. Many studies have evaluated the risk factors for severe perineal lacerations. However, the results of those studies are inconsistent, and meta-analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking. Systematic review and meta-analysis of cohort studies based on the PRISMA guideline. PubMed, Embase, the Cochrane Library, CINAHL, ClinicalTrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random-effects or fixed-effects model. A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12-1.92) and pre-pregnant underweight (OR: 1.31, 95% CI 1.22-1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42-0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81-2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45-1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations. Severe perineal lacerations are associated with many factors, and evidence-based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations. This systematic review and meta-analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.

Influence of introducing a maneuverable vacuum extractor cup on maternal hospital stay after instrumental birth. Retrospective cohort study

ObjectivesThe aim of our study is to evaluate the impact of the introduction of a maneuverable vacuum extractor cup on the length of hospital stay after assisted vaginal birth in nulliparous women in a hospital where no vacuum devices were used. MethodsThis single center retrospective analytical study included two groups of nulliparous women who had undergone an assisted vaginal birth. The 2 groups differ according to the availability or not of a maneuverable vacuum extractor cup. The first group includes the last 54 instrumental births until May 2017, when only obstetric forceps and Thierry's spatulas were available in our center; the second group includes the first 54 instrumental births since May 2018 in our center, when obstetric forceps, Thierry's spatulas and maneuverable vacuum extractor cup were available. Maneuverable vacuum extractor cups had been available for 12 months in the second group. ResultsIn the no vacuum cup group, Kjelland forceps and Thierry's spatulas were used in 29 (53.7%) and 25 (46.3%) of the 54 assisted vaginal births, respectively. In the vacuum available group, a vacuum cup was chosen in 30 (55.6%), Kjelland forceps were used in 18 (33.3%) and Thierry's spatulas in 6 (11.1%) of the assisted vaginal births. 22 women (40.7%) had a postpartum hospital stay longer than 3 days in the group with no maneuverable vacuum extractor cup availability, versus 3 women (5.6%) in the group with availability of a maneuverable vacuum extractor cup, p<0.001. Average postpartum hospital stay length was 3.17±0.803 days versus 2.81±0.585, p<0.001. There was also a significant reduction in the number of episiotomies. ConclusionThe introduction of a maneuverable vacuum extractor cup in a center where only forceps and Thierry's spatulas had been used resulted in a decrease in postpartum hospital stay in nulliparous women.

The tale of torn Descemet's membrane

To report three cases of late presentations of forceps birth trauma leading to DM tear and their management. Forceps delivery has become a rare method of child delivery in the modern clinical era. However, in the clinics, we still see patients with Descemet's membrane (DM) tear who have had ocular birth trauma with forceps. Most of the time, it is an incidental finding. Forceps injuries are usually unilateral and affect the left eye as the most common fetal head position is left occiput anterior. In the immediate postpartum period, the rupture in the DM leads to corneal edema, which eventually disappears, leaving the visible edges of the break. In the late presentations, patients can have high myopic astigmatism (steep cornea) and secondary amblyopia, which can mimic unilateral keratoconus and, later in life, can lead to corneal endothelial decompensation leading to bullous keratopathy. Here we report three cases of DM tear due to forceps injury with three late presentations. Patient 1 came with bullous keratopathy; patient 2 presented with high myopic astigmatism, amblyopia, and beaten metal appearance in between the torn edges; and patient 3 presented as keratoconus. To conclude, this case series highlights the various clinical features and signs of forceps induced birth injury to the cornea. In this report, the clinical history, ocular examination, and optical coherence tomography scan confirmed the diagnosis. Early rehabilitation with glasses or contact lenses can prevent the development of deep amblyopia. Corneal decompensation can be a presentation later in life; thus, these patients should have a close follow up. Endothelial keratoplasty helps in visual rehabilitation in cases where bullous keratopathy has developed, which can be up to the preoperative amblyopia state.

Efficacy of the Atraumatic Physics Forceps Over Conventional Extraction Forceps in Extraction of Tooth-Does it Offer an Alternative in All Types of Extraction or Only can be Used in Few Selected Types of Extraction: A Comparative Study.

We conducted this study to evaluate the efficacy of physics forceps in dental extractions as compared with conventional forceps and as well as to evaluate its atraumatic point of view.Materials and Methods:A total of 200 healthy adult patients were included in the study who reported for dental extractions, divided into two groups each containing 100 patients. The patients were randomly allocated into either group by lottery method.Results:Operating time in the physics forceps group was found to be significantly reduced as well as lesser incidence of dry socket was noted which was statistically significant on the 2nd day postoperatively. However, incidence of root fracture, buccal plate fracture, and gingival lacerations were not found to be statistically significant but their occurrence was less in the physics forceps group as compared with the conventional forceps group.Conclusion:To conclude, we can say that extractions done by physics forceps results in significant reduction in unnecessary trauma as well as stress to both the operator and patient. The forceps is an atraumatic extraction system which is a boon for the profession, thereby reducing ridge deformities and preparing the patients for future prosthesis.

Risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in 2020-2021: A retrospective study

Introduction: Vesicovaginal fistulae (VVF) and rectovaginal fistulae (RVF) are major public health concerns especially in sub-Saharan Africa. Our hypothesis was that prolonged obstructed labour, teenage marriages, inadequate emergency obstetric care and poverty are responsible for a high prevalence of VVF and RVF in South Sudan.Objective: The objective of the study is to determine the risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in South Sudan.Method: Data were obtained from the files of all the 40 women who were operated on for VVF and RVF in Juba Teaching Hospital (JTH) during the 2020 and 2021 fistula campaigns; three women were interviewed.Results: Thirty-six women had VVF, two had RVF and two had both. The main cause was obstructed labour. Spontaneous vaginal delivery accounted for 22 cases, Caesarean Section for 13 while five had a forceps delivery. Four women were aged under 18 years; the age of marriage was below 18 years for 22 women and between 18-25 years for 18 women. Of these 40 women 21 were para 1 &amp; 2,14 were para 3 to 5 and five were para 6 and above; 17 had delivered at home and 23 in hospital; 18 had been attended by midwives / doctor and 22 by Traditional Birth Attendants (TBAs) in the villages; 22 were in labour for more than three days. Thirty-two deliveries had resulted in stillbirths. Most women had not been to school, and all were classified as ‘poor’. Almost all (38) had not attended an ante-natal clinic (ANC) duringthe pregnancy in which they developed fistula. Ten women were operated on more than three times, 10 twice and 20 once. Nine women were divorced after developing fistula and 13 were abandoned. The psychosocial consequences included childlessness, stigmatization, depression, divorce, and abandonment.Conclusion: The main risk factor for developing obstetric fistula was prolonged obstructed labour. Secondary risk factors were delivering at home, lack of obstetric care facilities, deliveries attended by unskilled health workers and TBAs, poor ANC attendance during pregnancy, cultural factors that encourage early marriage, low socioeconomic status, and lack of education.

Is urethral pressure associated with parity and delivery mode?

Stress urinary incontinence is the most prevalent type of urinary incontinence and childbirth is a risk factor. The aim of this study is to evaluate the association between delivery mode and urethral sphincter function as measured by the maximum urethral pressure (MUP). A retrospective study on women seen in a tertiary urogynaecological center for urodynamic testing between January 2017 to December 2019. Women were classified into the following groups: (1) nulliparous; (2) caesarean section only; (3) at least one spontaneous vaginal delivery but no instrumental deliveries; (4) at least one vacuum delivery but no forceps; (5) at least one forceps delivery. The complete data sets of 1238 women were analysed; 1112 (90%) were vaginally parous. Mean age was 58 (18-95) years. Mean parity was 2.6 (0-9); 57 (4.6%) were nulliparous, 69 (5.6%) had only been delivered by caesarean section, 762 (61.6%) had at least one spontaneous vaginal delivery but no instrumental deliveries, 41 (3.3%) had at least one vacuum but no forceps delivery, and 309 (25%) had at least one forceps delivery. Mean MUP was 41.8 cmH2O. There was a significant association between vaginal parity and MUP (P < 0.001). On ANOVA test, delivery mode was significantly associated with MUP. This became nonsignificant on regression analysis, with only age significantly associated with MUP (P < 0.001). The effect of childbirth on urethral sphincter function seems to be largely due to the first vaginal birth. We failed to show an effect of instrumental delivery.

“Labia Majora Fasciocutaneous Flap Reconstruction in Complex Urogynecological Fistulas With Vaginal Deficit - A Versatile Approach”

ObjectiveTo appraise the pivotal points of different modifications of labia majora fasciocutaneous flap in combating the challenges of complex urogynecological fistula repair in the form of 7 cases. MethodsSeven patients with complex urogynecological fistulas with vaginal deficit were treated over last 3 years. The challenges associated with them were non-capacious rigid vagina, irradiated and inflamed surrounding tissues, inelasticity, long-standing fistula with radiation-induced vesicovaginal fistula(VVF), an iatrogenic urethrovaginal fistula with anterior vaginal wall loss with vaginal stenosis, and a case of vesicolabial fistula with a history of forceps delivery and transvaginal VVF repair. Transvaginal repair with labia majora fasciocutaneous flap along with fat pad with relevant technical modifications was contemplated in all. ResultsAll radiation-induced VVF patients demonstrated no leak in the postoperative period barring one who became dry after transvaginal colpocleisis later. The patient with urethrovaginal fistula and vaginal stenosis was continent, had capacious vagina, and without any leak with regular menstrual periods. The female with vesicolabial fistula remained dry at the end of 6-month follow-up. ConclusionTransvaginal repair using the labia majora fasciocutaneous flap and the demonstrated technical modifications can be a feasible option in repairing complex urogynaecological fistulas associated with vaginal wall deficit.

Diagnosis of Levator Ani Muscle Avulsion in Instrumented Delivery: Meta-analysis

Objective: The objective of this meta-analysis was to establish the rates of levator ani muscle (LAM) avulsion in patients after forceps delivery (FD) and vacuum delivery (VD) as assessed by 3D/4D transperineal ultrasound. Methods: A systematic search was performed in the MEDLINE, PubMed, Google Scholar, and Embase databases up to December 31, 2021. Studies that studied primiparous women diagnosed with LAM avulsion by 3D/4D transperineal ultrasound in VD or FD were included. To do the meta-analysis, the jamovi project program version 2.2 (2021) was used. Results: The search yielded 1225 studies that met the MeSH criteria, of which 26 were included in the review. The estimated joint OR for VD vs. normal vaginal delivery (NVD) was 1.93 (95% CI: 1.31–2.86), for FD vs. NVD was 5.33 (95% CI: 3.78–8.11), and for FD vs. VD was 2.36 (95% CI: 1.46–3.84). Conclusions: Instrumented delivery with forceps or vacuum favors LAM avulsion. It is not possible to establish whether this injury is attributable to the specific instrument or to the type of delivery involved in the instrumentation itself.

Clinical Presentation and Treatment Outcomes of Foreign Bodies in the Ear among Patients Attended at Bugando Medical Centre, Mwanza, Tanzania

Background: Globally, foreign bodies (FBs) in the ear are commonly encountered by otolaryngologists and its removal can result in complications if attempts of removal are made outside the healthcare setting by untrained personnel. This study describes the clinical presentation and treatment outcomes among patients presenting with FB s in the ear at Bugando Medical Centre (BMC). Methods: This was a cross sectional study that was conducted at BMC between May 2019 and October 2019. Results: A total of 70 patients (M: F ratio = 1.3:1) were studied. The mean age at presentation for children was 5.1[±2.2] years, whereas that of adults was 28.9 [±16.1] years. The FBs were found in the right ear in 44(62.9%) patients, left ear in 25(35.7%) patients and in both ears in 1(1.4%) patient. Cotton was the most common FB in 34.3% of cases. Previous history of failed attempted ear FB removal by peripheral hospitals was reported in 15(21.4%) patients. Methods used in the removal of ear FB were ear syringing in 42(60.0%) patients, forceps extraction in 15(21%) cases, FB removal by suctioning 4(6%) and hooks in 9(15%) patients. Complications observed were external ear canal laceration (n=13; 50.0%), tympanic membrane perforation (n=9; 34.6%), otitis externa (n=3; 11.5%) and chronic otitis media (n=1; 3.8%) and were significantly associated with late presentation (≥ 7 days) (p-value =0.021) and previous history of failed attempted ear FB removal (p-value &lt; 0.001). The outcome of treatment was excellent as all of the ear FBs were successfully removed with good improvement in hearing and clinical relief of symptoms. Conclusion: Ear FBs are common at BMC with the highest incidence in children less than 10years. Removal attempts by peripheral hospitals and delayed attending to specialized hospitals predisposes to complications. Parental education on close monitoring of their children to avoid such incidences and the need to immediately seek otorhinolaryngologists to prevent ..............

A Case of Preeclampsia with Uterine Necrosis after Uterine Artery Embolization for Postpartum Hemorrhage

Uterine necrosis is a rare complication in uterine artery embolization (UAE) for postpartum hemorrhage (PPH). Preeclampsia (PE) is a condition characterized with systemic endothelial damage and intravascular volume depletion. Whether a patient with PE is at high risk for uterine necrosis after UAE for PPH has been unknown. A 30-year-old primipara woman was diagnosed with PE based on hypertension and proteinuria during delivery. UAE was performed for PPH after forceps delivery. After UAE, the patient presented with pleural effusion and massive ascites as well as persistent fever unresponsive to antibiotics. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) led to the diagnosis of uterine necrosis, for which we performed total laparoscopic hysterectomy. It should be kept in mind that patients with PE associated with massive ascites may be at high risk for uterine necrosis after UAE due to decreased uterine perfusion. Therefore, it is important to pay attention to persistent symptoms such as fever and abdominal pain after UAE to diagnose uterine necrosis.

Epidural analgesia-efficacy and feto-maternal outcome: A cross sectional study

The delivery of an alert and active baby into the arms of a conscious and pain free mother is one of the most exciting and rewarding experiences in medicineEpidural analgesia is considered one of the most effective methods for pain relief during labor, and the intrapartum use of epidural analgesia has substantially increased over the previous two decades.To study efficacy of epidural analgesia in labour and its feto-maternal outcome.Present descriptive observational study was conducted at a tertiary care hospital. The study was conducted over the period one year from 2019 to 2020. Pregnant women reporting for delivery at study setting were the study population. Healthy pregnant primigravidae or multigravida women who had gestational age of greater than 37 weeks without any risk factors, in true labour with vertex presentation of fetus were included after obtaining an informed consent.Total number of patients were 50 with mean age 23.57 ± 2.73. Mode of delivery in 70% (35) parturient was spontaneous while 14% (07) and 6% (03) had forceps and vacuum delivery respectively. The remaining 10% (5) underwent lower section caesarian section (LSCS). The mean Apgar score of babies at one minute and at 5 minutes was 9.0±1.5and 9.6±1.4 respectively. Majority of the mothers were relieved from pain after epidural analgesia. Present study concludes that Epidural analgesia provides good pain relief in majority of the patients without any evidence of foeto-maternal compromise.

Rapid Cycle Deliberate Practice Versus Traditional Simulation to Improve Resident Performance in Forceps Deliveries

This study aimed to assess the effectiveness of rapid cycle deliberate practice (RCDP) in improving obstetrics and gynaecology residents’ performance and skill retention in forceps-assisted vaginal deliveries. Thirty-three residents were randomly assigned to RCDP or traditional debriefing. Performance was evaluated using an objective structured assessment of technical skills (OSATS) tool. There were no significant differences in immediate performance scores between groups (P = 0.082). At 4–6 months, both groups demonstrated improved performance scores (traditional, P = 0.001; RCDP, P = 0.001). Seventy-six percent of residents in the RCDP group indicated “real-time” feedback was advantageous. Three residents suggested this method was less beneficial at a senior level.

Sexuality of the woman during pregnancy: Experience of the Tunisian woman

ABSTRACT Introduction During various life transitions, sexuality can be disturbed and must be adjusted accordingly. This is particularly the case during pregnancy. This period is full of simultaneous multidimensional upheavals of a biological, physiological, psychological, emotional, social and sexual nature for the future parents. Objective To determine the factors associated with sexual dysfunction in a population of Tunisian women during pregnancy. Methods Multicentric prospective analytic study including 300 pregnant Tunisian women using the Arabic version of the Female Sexual Function Index (FSFI). Results We found a significant decrease in sexual frequency in rural versus urban settings (p=0.002). All sexual function items were significantly impaired in rural settings, except for orgasm and satisfaction. The FSFI score was lower for rural women (p=0.001). The type of marriage also proved to be a determining factor in the sexual life of pregnant women. In fact, in couples where the marriage was traditional, we noted a greater decrease in sexual relations (p &amp;lt; 0.01). All sexual function items were significantly impaired compared to couples where the marriage was for love. The item most affected was arousal (p&amp;lt;0.001). Nevertheless, pain was less during sexual intercourse for couples who had a love marriage (p&amp;lt;0.001). The decrease in frequency of intercourse was estimated at 78.33% when the agreement was poor, compared to only 49.68% when the marital agreement was good. The items most affected were orgasm, desire and arousal for couples with poor agreement. The FSFI score was also significantly impaired for this category (p &amp;lt;0.01). Similarly, women who frequently or always talked with their husbands about sexuality showed more desire, arousal, lubrication, orgasm and satisfaction with better overall sexual function on the FSFI. Another factor that appeared to negatively influence sexual function in pregnant women was a history of instrumental forceps delivery. Indeed, it was responsible for a significant impairment of arousal, orgasm and lubrication. It was also responsible for a more marked sexual dysfunction (FSFI score at 12.21 vs 22.76 in the absence of previous forceps delivery; p=0.01). Conclusion Pregnancy is certainly a period of vulnerability for the woman and her partner, but this is not a reason for it to be a desert of several months for the intimacy of the couple. Sexuality should no longer be considered as a tool for procreation only, but rather as a source of pleasure and relaxation and a privileged moment of complicity between the partners. Adapting to the events of pregnancy and the changes that are inherent to it requires the support of the family and the medical profession. Disclosure Work supported by industry: no.

The prevalence and characteristics of perineal rupture during vaginal delivery at Sanglah General Hospital and Regional Hospitals in Bali from January 2018 until December 2019 period

Background: One of the causes contributing to the high maternal mortality rate in Indonesia is postpartum hemorrhage, which can be the consequence of perineal rupture. Perineal rupture can happen spontaneously in normal vaginal delivery or worsen after episiotomy, induction of labor, vacuum and forceps delivery. This study aims to know the prevalence and characteristics of perineal rupture so that it can be used as data to make policy guidelines for preventing and reducing the incidence of perineal rupture. Methods: This is a retrospective descriptive study analyzing secondary data collected from Sanglah General Hospital and nine other Regional Hospitals from January 2018 until December 2019. The data analysis technique used is a univariable analysis by calculating the frequency distribution and proportion to determine the prevalence and characteristics of the research subjects. Data were analyzed using SPSS version 20 for Windows. Results: There are 8,178 cases of vaginal delivery, 6,191 cases (75.70%) with perineal rupture and 1,987 cases (24.30%) without perineal rupture. Perineal rupture is most often found in women &lt; 20 years old (82.66%), primigravida (81.76%), preterm gestational age (78.23%), the baby with birth weight &gt; 4,000 grams (94.26%), underweight mother (87.50%), and women with assisted delivery by vacuum or forceps (100.00%). Conclusion: The Prevalence of perineal rupture in this study is 75.70%, with the most characteristics being women &lt; 20 years old, primigravida, preterm gestational age, macrosomia baby, normal IMT, assisted vaginal delivery.

Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case\u2013control study

BackgroundObstetric anal sphincter injury (OASI) is a common and severe complication of vaginal delivery and may have short- and long-term consequences, including anal incontinence, sexual dysfunction and reduced quality of life. The rate of OASI varies substantially between studies and national birth statistics, and a recent meta-analysis concluded that there is a need to identify unrecognized risk factors. Our aim was therefore to explore both potential modifiable and non-modifiable risk factors for OASI.MethodsWe performed a case–control study in a single center maternity clinic in South-Eastern Norway. Data were extracted retrospectively from an institutional birth registry. The main outcome measure was the occurrence of the woman’s first-time 3rd or 4th degree perineal lesion (OASI) following singleton vaginal birth after 30 weeks’ gestation. For each woman with OASI the first subsequent vaginal singleton delivery matched for parity was elected as control. The study population included 421 women with OASI and 421 matched controls who gave birth during 1990–2002. Potential risk factors for OASI were assessed by conditional logistic regression analyses.ResultsThe mean incidence of OASI was 3.4% of vaginal deliveries, but it increased from 1.9% to 5.8% during the study period. In the final multivariate regression model, higher maternal age and birthweight for primiparous women, and higher birthweight for the multiparous women, were the only non-modifiable variables associated with OASI. Amniotomy was the strongest modifiable risk factor for OASI in both primi- (odds ratio [OR] 4.84; 95% confidence interval [CI] 2.60–9.02) and multiparous (OR 3.76; 95% CI 1.45–9.76) women, followed by augmentation with oxytocin (primiparous: OR 1.63; 95% CI 1.08–2.46, multiparous: OR 3.70; 95% CI 1.79–7.67). Vacuum extraction and forceps delivery were only significant risk factors in primiparous women (vacuum: OR 1.91; 95% CI 1.03–3.57, forceps: OR 2.37; 95% CI 1.14–4.92), and episiotomy in multiparous women (OR 2.64; 95% CI 1.36–5.14).ConclusionsAmniotomy may be an unrecognized independent modifiable risk factor for OASI and should be further investigated for its potential role in preventive strategies.

Operative Vaginal Delivery

The history of operative vaginal delivery dates back to 1500 B.C. In modern practice, the use of obstetrical forceps to achieve a vaginal delivery has been steadily declining. However, there has been a movement to revive this skill as a means for avoiding a cesarean delivery. Although the use of forceps and vacuum devices to assist in vaginal delivery can be extremely helpful in expediting delivery in emergency and other indicated situations, there are potentially serious complications for both the mother and fetus that must be addressed during the informed consent process. The operator must also be well versed in forceps and vacuum technique to prevent these complications from occurring. This involves training during residency and afterward to teach and practice skills. Appropriate candidate selection and proper technique for forceps and vacuum deliveries are crucial for optimizing safety for the patients while providing an alternative to a cesarean delivery. This review contains 12 figures, 7 tables and 36 references Keywords: forceps, vacuum, operative delivery, history of, complications, technique, tutorial

Cutaneous Pili Migrans: A Rare Case from North India

Cutaneous Pili Migrans (CPM) is a rare creeping eruption with only 40 cases reported so far. CPM is defined as a condition where a hair shaft or fragments gets embedded in superficial skin. It is known to affect both adults and children. We report a 23-year-old male patient who presented with sudden sharp pain in the foot on walking. Cutaneous examination revealed a black linear thread-like lesion on the medial plantar aspect of the right great toe associated with mild to moderate tenderness. The particle was removed by superficial paring along with gentle forceps extraction. Microscopic examination confirmed it to be a hair shaft fragment. While the exact etiology of CPM is unclear, it is proposed to be an acquired condition. Since it can mimic other creeping eruptions like Larva migrans, it is important to be aware of this condition.