Forceps Delivery Research Articles

Pilot study exploring the incidence of lower urinary tract symptoms during pregnancy in a district general hospital in Northern Ireland: a prospective survey.

The objective of this study was to ascertain the prevalence of lower urinary tract symptoms (LUTS) during pregnancy with a prospective survey in the UK. Pregnant women over the age of 18 years booked for shared antenatal care at a district general hospital were asked to complete a validated 14-stem questionnaire enquiring about lower urinary tract symptoms. (ICIQ-FLUTS). Primary outcome measure was completion of the ICIQ-FLUTS questionnaire. Secondary analysis included the prevalence and odds ratios of individual symptoms that make up the ICIQ-FLUTS score. In all, 383 women completed the questionnaire. The most common symptom reported was urgency with a prevalence of 80%. Urgency was over twice as likely to be reported in those with a BMI > 30. The next most common symptom reported was stress incontinence with 65% of participants reporting some leakage on exertion. The likelihood of reporting stress incontinence increased with parity, BMI > 30 and participants in the third trimester with odds ratios of 1.81, 2.07 and 2.09, respectively. Women were almost four times more likely to report any type of urinary incontinence if they had had a vaginal birth in their first pregnancy compared to those who had a caesarean section and women who had a forceps delivery were seven times more likely to report incontinence. The antenatal period may represent an important opportunity for health promotion and intervention. The high prevalence of LUTS in our antenatal population highlights the need to educate women on bladder care.

Operative vaginal delivery: all you should know.

Over the last three decades, the decrease in operative vaginal delivery (OVD) has lead to an increase in the rate of cesarean sections, giving rise to intense debate amongst healthcare providers. As the use of vacuum and forceps requires personnel be adequately trained so as to become familiar with the correct use of instruments, the lack of skilled and experienced instructors may well lead to this technique being discarded in the near future. The aim of this study was to review the literature, compare the recommendations from international OVD guidelines and to illustrate the correct technique of obstetrical vacuum and forceps application to promote OVD among clinicians as a safe way of delivery.

An Initiative to Increase Resident Performance of Operative Vaginal Deliveries.

The objective of this single-centre, action research study was to increase resident experience performing operative vaginal deliveries. The secondary objective was to assess the incidence of maternal and neonatal complications. The rate of forceps deliveries increased in the post-training period (1.8%-4.0%; P < 0.001) but the overall rate of operative vaginal delivery did not change. The composite maternal complications rate following forceps delivery was lower in the post- training period (P = 0.006). There were no significant differences in maternal or neonatal complications with vacuum delivery between the periods before and after the initiative. Experiential training of residents may be a viable alternative to simulation training as it does not require expensive state-of-the-art simulation technology.

Developmental defects of enamel, sociodemographic aspects and systemic diseases: Is there association?

Objective: Evaluate the prevalence of developmental defects of enamel (DDE) in permanent molars and its association with sociodemographic characteristics and systemic conditions in children treated at the paediatric dentistry clinic of private dental school. Material and Methods: The sample consisted of 706 medical records of children aged 8 to 12 years of both sexes, treated between 2004 and 2017. The inclusion criteria included the presence of the first 4 permanent molars, absence of syndromes related to enamel malformations and dentoalveolar trauma in the first 3 years of life and complete medical records. The dependent variable (hypomineralization/hypoplasia) and the independent variables (sociodemographic and health variables) were collected and evaluated using descriptive analysis, association tests (chi-square) and logistic regression, at a significance level of 5%. Results: The prevalence of DDE in the first permanent molars was 55.95%, with no association with sociodemographic characteristics. Conclusions: The association of DDE in the first 4 permanent molars with the independent variables such as caesarean, forceps or preterm delivery and systemic diseases until 3 years of age were statistically significant.

A randomized controlled trial of prophylactic early manual rotation of the occiput posterior fetus at the beginning of the second stage vs expectant management

Women whose fetuses are in the occiput posterior head position at the time of delivery are known to have longer second stages of labor and more complicated deliveries including more operative deliveries (cesarean, forceps, or vacuum-assisted delivery) and more third- and fourth-degree lacerations than those whose fetuses are in the occiput anterior position. We hypothesized that rotating the fetus at the start of the second stage might decrease these complications. At Utah Valley Regional Medical Center, we randomized term (37 weeks or beyond), nulliparous patients with epidurals and a singleton fetus in the occiput posterior position to either attempted early manual rotation to occiput anterior or to a control group managed expectantly. The control group could later be rotated if indicated by the clinical setting. The primary outcome was the length of the second stage of labor. Dichotomous outcomes were compared utilizing the chi-square test, and continuous outcomes were compared utilizing the Student t test or Wilcoxon rank sum test.The sample size estimate was for 64 patients to be randomized (32 in each group) to show a difference of 36 minutes of pushing time between the 2 groups. We randomized 65 patients (33 to early manual rotation and 32 to control). When we examined a variety of baseline obstetrical characteristics, we found no statistically different values for the 2 groups. The early manual rotation group had a shorter median second stage of labor (65 minutes vs 82 minutes; P=.04). Early manual rotation of the occiput posterior fetus led to a shorter second stage of labor in this small randomized trial. Future larger randomized trials are needed to validate these findings.

Japanese Practice Guidelines for Fecal Incontinence Part 1-Definition, Epidemiology, Etiology, Pathophysiology and Causes, Risk Factors, Clinical Evaluations, and Symptomatic Scores and QoL Questionnaire for Clinical Evaluations-English Version.

Fecal incontinence (FI) is defined as involuntary or uncontrollable loss of feces. Gas incontinence is defined as involuntary or uncontrollable loss of flatus, while anal incontinence is defined as the involuntary loss of feces or flatus. The prevalence of FI in people over 65 in Japan is 8.7% in the male population and 6.6% among females. The etiology of FI is usually not limited to one specific cause, with risk factors for FI including physiological factors, such as age and gender; comorbidities, such as diabetes and irritable bowel syndrome; and obstetric factors, such as multiple deliveries, home delivery, first vaginal delivery, and forceps delivery. In the initial clinical evaluation of FI, the factors responsible for individual symptoms are gathered from the history and examination of the anorectal region. The evaluation is the basis of all medical treatments for FI, including initial treatment, and also serves as a baseline for deciding the need for a specialized defecation function test and selecting treatment in stages. Following the general physical examination, together with history taking, inspection (including anoscope), and palpation (including digital anorectal and vaginal examination) of the anorectal area, clinicians can focus on the causes of FI. For the clinical evaluation of FI, it is useful to use Patient-Reported Outcome Measures (PROMs), such as scores and questionnaires, to evaluate the symptomatic severity of FI and its influence over quality of life (QoL).

Risk Factors for Postpartum Hemorrhage and its Severe Forms with Blood Loss Evaluated Objectively - A Prospective Cohort Study.

To identify risk factors related to postpartum hemorrhage (PPH) and severe PPH with blood loss quantified objectively. This is a complementary analysis of a prospective cohort study that included pregnant women delivering vaginally. The total blood loss was obtained through the sum of the volume collected from the drape with the weight of gauzes, compresses and pads used by women within 2 hours. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. The risk factors for postpartum bleeding were evaluated using linear and logistic regression. We included 270 women. The mean blood loss at 120 minutes was 427.49 mL (±335.57 mL). Thirty-one percent (84 women) bled > 500 mL and 8.2% (22 women) bled > 1,000 mL within 2 hours. Episiotomy, longer second stage of labor and forceps delivery were related to blood loss > 500 mL within 2 hours, in the univariate analysis. In the multivariate analysis, only forceps remained associated with bleeding > 500 mL within 2 hours (odds ratio [OR] = 9.5 [2.85-31.53]). Previous anemia and episiotomy were also related to blood loss > 1,000mL. Prolonged second stage of labor, forceps and episiotomy are related to increased incidence of PPH, and should be used as an alert for the delivery assistants for early recognition and prompt treatment for PPH.

Persistent occiput posterior position outcomes following manual rotation: a randomized controlled trial

Persistent occiput posterior position in labor is associated with adverse maternal and perinatal outcomes. Prophylactic manual rotation from the occiput posterior position to the occiput anterior position in the second stage of labor is considered a safe and easy to perform procedure that in observational studies has shown promise as a method for preventing operative deliveries. This study aimed to determine the efficacy of prophylactic manual rotation in the management of occiput posterior position for preventing operative delivery. The hypothesis was that among women who are at least 37 weeks pregnant and whose baby is in the occiput posterior position early in the second stage of labor, manual rotation will reduce the rate of operative delivery compared with the "sham" rotation. A double-blinded, parallel, superiority, multicenter, randomized controlled clinical trial in 4 tertiary hospitals was conducted in Australia. A total of 254 nulliparous and parous women with a term pregnancy and a baby in the occiput posterior position in the second stage of labor were randomly assigned to receive either a prophylactic manual rotation (n=127) or a sham rotation (n=127). The primary outcome was operative delivery (cesarean, forceps, or vacuum delivery). Secondary outcomes were cesarean delivery, combined maternal mortality and serious morbidity, and combined perinatal mortality and serious morbidity. Analysis was by intention to treat. Proportions were compared using chi-square tests adjusted for stratification variables using the Mantel-Haenszel method or the Fisher exact test. Planned subgroup analyses by operator experience and by manual rotation technique (digital or whole-hand rotation) were performed. Operative delivery occurred in 79 of 127 women (62%) assigned to prophylactic manual rotation and 90 of 127 women (71%) assigned to sham rotation (common risk difference, 12; 95% confidence interval,-1.7 to 26; P=.09). Among more experienced operators or investigators, operative delivery occurred in 46 of 74 women (62%) assigned to manual rotation and 52 of 71 women (73%) assigned to a sham rotation (common risk difference, 18; 95% confidence interval,-0.5 to 36; P=.07). Cesarean delivery occurred in 22 of 127 women (17%) in both groups. Instrumental delivery (forceps or vacuum) occurred in 57 of 127 women (45%) assigned to prophylactic manual rotation and 68 of 127 women (54%) assigned to sham rotation (common risk difference, 10; 95% confidence interval,-3.1 to 22; P=.14). There was no significant difference in the combined maternal and perinatal outcomes. Prophylactic manual rotation did not result in a reduction in the rate of operative delivery. Given manual rotation was associated with a nonsignificant reduction in operative delivery, more randomized trials are needed, as our trial might have been underpowered. In addition, further research is required to further explore the potential impact of operator or investigator experience.

Compression-hypoxic birth injuries and skull configuration

The fetus has birth traumatic, compression-hypoxic, and hypoxic-ischemic brain lesions during childbirth. There are problems in their differentiation in clinical and anatomopathological practice. It is proposed to divide birth traumatic injuries into two types: 1) obvious traumatic injuries and 2) compression-hypoxic traumatic injuries. Signs of compression-hypoxic birth injuries were found in 24.4% of the examined fetuses and newborns delivered via vacuum extraction and application of obstetric forceps. This allows compression hypoxia to be attributed to birth injury rather than to hypoxic-ischemic encephalopathy. It is proposed to use the concept of compression-hypoxic birth injury. The morphological signs that are characteristic of this type of birth injury are given. It is indicated that the impact of physical forces on the fetal head is mediated by its configuration. The mechanisms of birth traumatic injuries are systematized. The pathological configuration of the fetal head is shown to be of importance in explaining the cause of birth injury.

Congenital Facial Palsy- A Rare Case Report

Congenital facial palsy is a very rare entity with an incidence of 2 per 1000 live births. It can be congenital, traumatic associated with birth trauma in the form of forceps delivery or developmental. We present the case of a 1-year-old girl who presented to the eye department of our tertiary care hospital with a deviation of face to the right side since birth along with watering of left eye and difficulty in taking feeds. There was a history of forceps-assisted vaginal delivery; a provisional diagnosis of congenital facial palsy was done with the probable cause of trauma.

Maternal birth trauma: how imaging can (and should) change clinical practice.

Maternal birth trauma: how imaging can (and should) change clinical practice.

Comparison of maternal and neonatal outcomes after forceps or spatulas-assisted delivery

ObjectiveThe aim of this study was to compare the perinatal outcomes associated with spatulas or forceps assisted delivery. Study designThis 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. ResultsOut 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. ConclusionIn 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.

A study evaluating the perinatal outcomes in teenage pregnancy

Teenage pregnancy is one of the important social problems faced worldwide. It increases the risk of neonatal mortality and also significantly deteriorates the health of the mother. The most common complication in teenage pregnancy includes anemia, preterm delivery, intrauterine growth restriction, preeclampsia and depression in the mother and increased risk of congenital malformation, sepsis inadequate weight gain and failure to thrive due to lack of maternal care in the neonate. This study evaluates the postnatal complications in teenage pregnancy (less than or equal to19 years). Lack of awareness, attainment of early puberty and early marriage are the important causes for prevalence of teenage pregnancy in India. A cohort retrospective study was done in the Obstetrics and Gynaecology Department at Saveetha Medical College and Hospital during the period January-July 2020; which involved collection of data from 2011-2019. This study shows among the teenage pregnancies 82% of cases had normal vaginal delivery,14% were delivered by cesarean section and 4% by forceps delivery. But there was no significant association between mode of delivery and teenage pregnancy. Moreover, teenage pregnancies had higher incidence of vaginal delivery. Also, Immediate Complications such as anemia, postpartum hemorrhage, Premture rupture of membranes, placenta previa, abruption, neonatal death and IUGR were seen in 27% cases and late complications such as inadequate weight again and failure to thrive were present in 43%. Although most patients delivered through normal vaginal delivery the complications in teenage pregnancy was found to be relatively more than pregnancy in an adult. The study showed that teenage pregnancy is a high risk pregnancy and can be promoted by sex education and emphasizing the importance of contraception.

Adequacy of Hand and Foot Massage on Post Cesarean Pain among Postnatal Mothers

Pregnancy is a curious rousing and as frequently as possible upbeat hour in a woman's life, as spots of interest the woman's bewildering innovative and headway capacity while allowing a relationship with what's to come. There is a wide range of techniques for labour. Vaginal delivery is one of the most widely recognized and most secure sorts of labour. At the point when vital in specific conditions, forceps and vacuum delivery might be utilized. Now cesarean delivery is fundamental for the most secure of mother and child. The cesarean segment is the most every now and again performed a medical procedure on the planet. The point of the Study is to the adequacy of Hand and Foot Massage on Post cesarean pain among postnatal moms. Exploration approach utilized for the investigation was the quantitative methodology. The examination configuration was semi trial plan (pretest and post test control group). A complete of 60 members were choosing with non - likelihood purposive inspecting procedure was utilized and factual strategy applied for the investigation. The investigation was directed in a government hospital at Thiruvallur. The mean pre-test score in the exploratory gathering was 6.4 and meant the post-test score was 3.5. The 't' esteem is 33.72, which was huge at p≤0.05 level. Subsequently, it demonstrated that Hand and Foot Massage was viable in diminishing pain among post-cesarean moms in the experimental group.

Exploring Machine Learning Algorithms to Find the Best Features for Predicting Modes of Childbirth

The mode of delivery is a crucial determinant for ensuring the safety of both mother and child. The current practice for predicting the mode of delivery is generally the opinion of the physician in charge, but choosing the wrong method of delivery can cause different short-term and long-term health issues for both mother and baby. The purpose of this study was twofold: first, to reveal the possible features for determining the mode of childbirth, and second, to explore machine learning algorithms by considering the best possible features for predicting the mode of childbirth (vaginal birth, cesarean birth, emergency cesarean, vacuum extraction, or forceps delivery). An empirical study was conducted, which included a literature review, interviews, and a structured survey to explore the relevant features for predicting the mode of childbirth, while five different machine learning algorithms were explored to identify the most significant algorithm for prediction based on 6157 birth records and a minimum set of features. The research revealed 32 features that were suitable for predicting modes of childbirth and categorized the features into different groups based on their importance. Various models were developed, with stacking classification (SC) producing the highest f1 score (97.9%) and random forest (RF) performing almost as well (f1-score = 97.3%), followed by k-nearest neighbors (KNN; f1-score = 95.8%), decision tree (DT; f1-score = 93.2%), and support vector machine (SVM; f1-score = 88.6%) techniques, considering all (n = 32) features.

The battle of the lower molar extraction forceps: cowhorn versus eagle beak

The battle of the lower molar extraction forceps: cowhorn versus eagle beak

The jury is still out on the genetics of pre-eclampsia.

The American obstetrician, Joseph DeLee, 'father of modern obstetrics', founded the Chicago Lying-in Hospital in 1931 with his vision for womens' health captured in a set of five stone plaques at the top of the cloister of the hospital's building. Four of the five stone plaques are engraved with the names of pioneering clinicians whose contributions to the field of obstetrics and gynaecology have been seminal: Jan Palfyn (1650-1730), for introducing the obstetric forceps in the 1720s.

Comparison of effectiveness disinfection of glutaraldehyde 2% and hydrogen peroxide 3% on tooth extraction instruments in Department of Oral Surgery and Maxillofacial, Faculty of Dentistry, University Sumatera Utara

Objective: To compare disinfecting effectiveness of Glutaraldehyde 2% and Hydrogen Peroxide 3% on tooth extraction instruments at the Department of Oral Surgery, Faculty of Dentistry, Universitas Sumatera Utara.Material and Methods: This was an experimental study with post-test only control group design approach. Purposive technique is applied to collect samples which are lower molar extraction forceps. In this study, sample were divided into 2groups and each consisting of 18instruments soaked in Glutaraldehyde 2% and Hydrogen Peroxide 3%. Each instrumentwere pre-cleaned using brush, water and soap for both group before going through disinfection process.Results: Statistically analyzed using Mann-Whitney Test. The comparison between Glutaraldehyde 2% and Hydrogen Peroxide 3%showedno significant difference to the total bacteria count on instrument after disinfection (p=0.014 &lt;0.05).Conclusion: Glutaraldehyde 2% showed more effective than Hydrogen Peroxide 3% in disinfecting lower molar extraction forceps.

Characteristics of hardness and microstructure of extraction forceps for dental and oral care made of stainless-steel

The reliability of medical devices such as extraction forceps is vital for dental and oral care. Apart from having hygienic properties, the extraction forceps must be strong and resistant to corrosion. This study evaluates the effects of tempering temperature on the hardness and microstructure of a medical device’s material made from stainless-steel DIN 4021. In the experiments, a heat treatment process was carried out previously with a temperature of 1,050°C and a holding time of 20 minutes. A quenching process was conducted using a cooling channel that flowed with water at 10-20°C. After the heat treatment, the material was subjected to a tempering process with temperature variations of 200, 400, and 600°C. The research results indicated that the heat treatment process could increase the material’s hardness —the hardness of the raw material changed from 20 to 48.67 HRC with the heat treatment. The tempering parameters resulted in the highest hardness of 46.67 HRC at 200°C and the lowest value of 42.33 HRC at 600°C. Microstructure testing using optical microscopy showed that it produced ferrite, pearlite, and martensite structures. In contrast, the result of a microstructure testing using Scanning Electron Microscopy on the surface of the material is that the higher the tempering temperature, the greater the microstructures’ dimension.

Puerperal sepsis and maternal outcome in developing countries: an observational study

Background: Puerperal sepsis is a major cause of maternal morbidity, mortality. Present study was conducted to know burden of severe puerperal sepsis, risk factors, maternal outcome. Methods: Present observational cohort study was conducted in the Obstetrics and Gynecology department of rural tertiary center of Northern India over eight months (1st January-31st July 2018). All women who had delivered or aborted in an institution or those referred from outside within 42 days of delivery/abortion having clinical features, investigations suggestive of puerperal sepsis were enrolled. Socio-demographic factors, clinical features, examination findings, investigations, details of antecedent pregnancy, complications, risk factors, and maternal outcome were recorded. Statistical analysis was done using SPSS version 22 software.Results: A total of 66 cases with severe puerperal sepsis were observed during the study period of which 55 (83.3%) were referred from outside. The most common mode of delivery in antecedent pregnancy was vaginal (42.4%) followed by cesarean section (33.3%) and one (1.5%) forceps delivery. There were 15 (22.7%) post-abortal cases. Maternal anemia was found to be significantly linked with sepsis and adverse maternal outcome (p&lt;0.05). Most common presenting features were fever (100%), tachycardia (100%), breathlessness (100%), malodourous vaginal discharge (100%), abdominal distention (53.0%), scar infection (16.7%), vaginal or rectal bleeding (16.7%), peritonitis (27.3%), septic shock (12.1%). A total of 38 (57.6%) cases required surgical intervention with seven (10.6%) developing multiorgan failure and 15 (22.7%) succumbed to death.Conclusions: Though puerperal sepsis is a preventable condition, it continues to be one of the major causes of maternal morbidity, mortality.