Low Forceps Research Articles

Neonatal Acidosis and Method of Delivery

Seven hundred and four women who had a forceps termination (177 elective, 293 indicated low, and 234 indicated midforceps) of labor over 24 months were compared with 303 spontaneous and 111 cesarean deliveries over the same time period. There was no significant difference between indicated low or midforceps either for fetal distress or arrest of descent with regard to fetal acidosis (pH less than 7.20), one- or five-minute Apgar scores less than 7, fetal trauma, or neurologic deficit at discharge. Fourteen percent of indicated forceps for arrest of descent had neonatal acidosis, versus 8% of cesarean sections for cephalopelvic disproportion (P = NS), and 23% of indicated forceps for fetal distress had acidosis, versus 33% of cesarean sections (P = not significant). There was no significant difference either in the incidence of acidosis or in low Apgar scores in neonates delivered by elective low forceps compared with those born by spontaneous vaginal delivery. The only significant differences in midforceps versus low forceps were between maternal pre- and postdelivery hematocrits (P less than .0001) and vaginal lacerations (P less than .0001). The authors' data support the continued usage of indicated low and selected midforceps operations.

The midforceps: Maternal and neonatal outcomes

A retrospective review of midforceps deliveries occurring between 1976 and 1982 at a county teaching hospital is presented. Midforceps deliveries were performed in 0.8% of deliveries (176 of 21,414) during this period, a rate reflecting the general admonition against potentially traumatic injury to the infant. Under these conditions, midforceps deliveries were associated with active and second-stage labor abnormalities, abnormal fetal heart rate patterns, maternal perineal lacerations, low 1-minute Apgar scores, and neonatal cephalohematomas more frequently than were deliveries of the remainder of the patients. Epidural anesthesia was significantly associated with midforceps deliveries. Midforceps patients were matched to similar groups who were delivered by cesarean section or low forceps or who had spontaneous births. The findings do not document an increase in short-term neonatal morbidity in the midforceps group under the conditions described.

Mode of delivery for low birth weight infants: Schwartz D, Miodovnik M, Lavin J: Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps. Obstet Gynecol 62:283, 1983

Mode of delivery for low birth weight infants: Schwartz D, Miodovnik M, Lavin J: Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps. Obstet Gynecol 62:283, 1983

Route of delivery for patients with immune thrombocytopenic purpura

Over the past 15 years, we managed 19 pregnancies in 18 women afflicted with immune thrombocytopenic purpura. Our policy has been to treat the mother with corticosteroids if her platelet count was below 100 × 109/L and to use cesarean section only for obstetric indications; 14 patients received corticosteroids. The perinatal outcomes were intrauterine fetal death (two), neonatal death (0), and live birth (17). The methods of delivery for the 17 live-born infants were spontaneous vaginal (seven), low forceps or midforceps (five), cesarean section (five). Although seven of the live-born infants (41%) were thrombocytopenic (<100 × 109/L), only two received therapy, and none suffered significant hemorrhagic morbidity. Maternal treatment with corticosteroids did not affect the neonatal platelet count, nor was there a correlation between maternal and neonatal platelet counts. On the basis of our experience, we think that cesarean section is not routinely indicated as the method of delivery for parturient patients with immune thrombocytopenic purpura.

Neonatal outcome among low birth weight infants delivered spontaneously or by low forceps.

In a population of 1065 singleton, low birth weight infants (1000 to 2500 g) delivered vaginally from vertex presentation, the neonatal mortality and morbidity of 394 delivered by low forceps were compared with those of 671 delivered spontaneously. There were no significant differences between the groups, either across the population as a whole or among any of the following birth weight subgroups: 1000 to 1500 g, 1501 to 2000 g, and 2001 to 2500 g. The data in the current study, as well as those from previous reports, argue against the routine use of prophylactic low forceps delivery and in favor of a more individualized approach to the vaginal delivery of infants in vertex presentation in this weight group.

Neonatal Haemophilus influenzae Type C Sepsis

An increased incidence of childhoodHaemophilus influenzaedisease, predominantlyH influenzaetype B meningitis, has been both reported1and refuted.2Nevertheless, recent reports do suggest a rise in neonatalH influenzaeinfection, predominantly owing to nontypable or nontype BH influenzaestrains.3-11 We describe a neonate with group CH influenzaesepticemia. Report of a Case.—A 3,160-g male infant was born to an 18-year-old woman (gravida 1, para 1) after a 37-week gestation that had been complicated by mild preeclampsia. Fetal membranes ruptured 15 hours before delivery. The infant was delivered by low forceps extraction, and Apgar scores were 7 and 9 at one and five minutes, respectively. A right-sided parietal cephalhematoma, forceps marks, and an abrasion on the right cheek were noted. At 18 hours of age, the infant had tachypnea, elevated temperature (38.5 °C), diminished activity, and a high-pitched cry. Initial laboratory values at

Forceps—Use and Abuse

All forceps operations are associated with a higher incidence of several birth-related injuries. Low forceps operations do not appear to significantly increase infant morbidity, but mid forceps deliveries are a subject of controversy. Suggestions are made for reducing the need for mid forceps deliveries and for the more liberal use of cesarean section whenever an easy forceps delivery is not expected.

Method of Delivery and Developmental Outcome At Five Years of Age

A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.

Submandibular Adenitis in a Newborn Caused by Mycoplasma hominis

Despite frequent colonization of the newborn infant with genital mycoplasmas, morbidity due to these organisms has been cited on few occasions. This report describes an infant with suppurative submandibular lymphadenitis from whom Mycoplasma hominis was isolated in pure culture. CASE REPORT A 2,580-gm, firstborn, black, female twin was the product of a 36-week pregnancy in a 15-year-old primigravida in whom mild preeclampsia and fever developed one day prior to delivery. After spontaneous rupture of the membranes and a 12-hour labor, the infant was delivered without complication by low forceps and vacuum extraction. Apgar scores were 7 and 9 at one and five minutes, respectively; findings on routine newborn examination were unremarkable.

METHOD OF DELIVERY AND DEVELOPMENTAL OUTCOME AT FIVE YEARS OF AGE

A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.

Persistent cloaca with absent penis and anal atresia in one of identical twins

PER S I S T E N C E of the primitive cloaca with absence of the urethra, absence of the external genitalia, and anal atresia is described in one sibling of a monoamniotic-mon ochorionic twin birth. The infant also had severe bilateral renal dysplasia but no evidence of pulmonary hypoplasia. CASE REPORT Mrs. B. is a 23-year-old secundigravida. Her first pregnancy was spontaneously aborted after two months. The present pregnancy, complicated by pre-eclampsia, was treated with hospitalization, bed rest, and pressure pills during the final two months. A twin pregnancy was diagnosed at this time. Desiccated thyroid, taken for a period of ten years because of a history of being overweight, was discontinued when the pregnancy was first diagnosed. The mother had been adopted and her family history was unavailable. Paternal family history was positive for twin births, but negative for renal disease, fetal wastage, or early death in the neonatal period. A subsequent third pregnancy has resulted in a normal girl. Spontaneous rupture of the fetal membranes occurred four hours prior to delivery. Twin A, the subject of this report, weighed 2,835 gin, and was delivered by elective low forceps. Apgar scores were 8 at one minute and 9 at five minutes. The delivery of Twin B was complicated by prolapse of the umbilical cord. At birth his weight was 3,246 gm and physical examination was that of a normal boy. The placenta was monoamniotic; both infants were blood type A Rh-negative. Twin A was transported to the Newborn Intensive Care Unit at the University of New Mexico School of Medicine. On admission the infant appeared alert and in no distress. Gestational assessment was consistent with a 40-week, appropriate-for-gestational age infant. The length was 48 cm and head circumference was 34 cm; the heart rate was 150/minute and respiratory rate 56/minute. Abnormal physical findings were limited to the abdomen and perineat area (Fig. 1). The abdomen was distended and had decreased muscle tone. A left upper quandrant mass, right flank mass, and suprapubic mass were palpated. Only two umbilical vessels could be identified. There was a rudimentary scrotal sac without palpable gonads in the sac or inguinal area. The remainder of the perineum was smooth, with no anal orifice or dimple.

Autoimmune (idiopathic) thrombocytopenic purpura in pregnancy and the newborn.

The effects of autoimmune (or idiopathic) thrombocytopenic purpura (ATP) on 51 pregnancies in 29 women is presented. There is no convincing evidence that the clinical course of ATP is influenced by pregnancy. There was no increased incidence of obstetric complications. No problems were encountered following spontaneous vaginal delivery or low forceps delivery. There were no perinatal deaths. Twenty newborn infants were studied in detail and significant thrombocytopenia was present in half of them. The severity of thrombocytopenia in the newborn correlated closely with the severity of maternal disease; those women in clinical remission following splenectomy but with presumed high levels of antiplatelet antibodies were those most likely to be delivered of affected newborn infants. The cord blood platelet count was the most reliable guide to the potential severity of the neonatal thrombocytopenia. Platelet counts were lowest between the second and fourth days of neonatal life. The management of the severely affected infant is discussed.

Plasma Cortisol Levels in Umbilical Cord Plasma and Its Change During the First Two Hours Following Delivery

Although assessment of adrenocortical function at birth has been made by several investigators, the results obtained do not agree well with one another. Also, knowledge of the cortisol level during the postnatal period was scanty. The purpose of the present study is : 1) to assess cortisol levels in normal newborns at birth and to compare them with levels in distressed newborns ; 2) to investigate changes of plasma cortisol levels in normal babies during the first 2 hours following delivery.Cortisol was measured in maternal and cord plasma, as well as in normal newborn plasma by a competitive protein-binding radioassay. An assessment of the reproducibility and precision of the method is presented. In maternal plasma, the average cortisol concentration (32. 4 μg/dl) was 2. 4 times greater than in umbilical arterial plasma (13. 3 μg/dl). The correlation coefficients do not suggest a significant relationship between the maternal and umbilical venous cortisol concentrations which means poor placental transfer of cortisol.To determine whether distressed infants showed evidence of adrenal cortical hyperfunction as compared to normal babies, serum cortisol levels were measured in infants delivered by vacuum extraction or forceps. No difference was found in circulation cortisol levels between these groups. However, Gemzell observed a higher 17-hydroxycorticosteroids concentration in the infants delivered by low forceps than in normal infants. These results suggest that the ability of the neonatal adrenal cortex to respond in the face of perinatal stress is variable according to individuals.Cortisol concentrations from normal infants at 1/2, 1, 2, 6, 12, 24 hours after birth were measured. In spite of individual variations and the limited number of observations, it is apparent that the cortisol concentration fell after birth. The levels of cortisone obtained at 1 hour of age were about half the levels at birth and were maintained during the first day of life.

The relationship between psychological variables and specific complications of pregnancy, labor, and delivery

Questionnaire data pertaining to psychological and health variables were obtained from private obstetrical patients. Groups of women with specific perinatal complications were compared with a no-complication control group on five psychological variables after variance due to the three health variables was partialled out statistically. Differences between the groups were obtained for seven of the fifteen complications: Uterine Intertia, Prolonged First Stage of Labor, Prolonged Second State of Labor, Rotation of the Infant's Head, Indicated Low Forceps, Infant Apgar Scale under 5, Infant Apgar Score 5–7.

Letter: Scrotal mass in a neonate: testicular abscess.

We would like to report the case of an infant found to have epididymoorchitis and a testicular abscess. Report of a Case.—A 2,600-gm (5.7-lb) infant born by low forceps to a 16-year-old, VDRL-negative primigravida appeared normal at birth. Circumcision was performed on the second day of life, and the genitalia were observed to be normal. On the third day of life the infant fed poorly and became visibly jaundiced. A distended abdomen with active bowel sounds and periumbilical erythema without discharge were noted. Suspecting sepsis, blood, urine, and cerebrospinal fluid cultures were obtained, and the infant was treated intravenously with antibiotics. The following day the blood culture yielded a Gram-negative rod, later identified asEscherichia coli. On the 14th day of life, a firm, tender mass measuring 2 cm in diameter was found in the right scrotum. The mass, which seemed to include the right testicle, was not erythematous

Vomiting In Utero with Intestinal Atresia

The fetus with high intestinal obstruction may vomit bile in utero. A green amniotic fluid with failure to pass meconium clinches the diagnosis. Case Report After an uncomplicated pregnancy, labor progressed with no signs of fetal distress—yet when the membranes were ruptured excessive amounts of green amniotic fluid appeared. The obstetcian diagnosed hydramnios with "meconium stained liquor." The fetal heart then dropped to 80 beats a minute and the infant (2.7 kg) was immediately delivered by low forceps. The cord was wrapped around the neck producing a face purple with ecchymoses. After unwrapping the cord greenish fluid was suctioned from the mouth and pharynx and over 30 cc from the stomach.

Pneumococcal meningitis and endophthalmitis in a newborn.

To the Editor.— Keyes et al recently reported an association between meningococcemia and endocervical infection in two patients and remarked on the uniqueness of this association. 1 We encountered a case in which a relatively asymptomatic pneumococcal infection of the endocervical area of a mother led to fatal pneumococcal meningitis in a live born infant who remained asymptomatic until 5 days of age. Report of a Case.— A 5-day-old female infant was born at term via low forceps delivery to a 23-year-old primigravida who had had an uneventful pregnancy except for mild preeclampsia. The child, with an initial apgar core of 3, required suction and oxygen, but within five minutes the respirations were normal. She received silver nitrate prophylaxis to the eyes, and on day 4 the child was discharged as a healthy newborn. The mother was disturbed by the foul odor of the vaginal discharge, but was afebrile and

ACID-BASE STATUS AND CLINICAL CONDITION OF MOTHER AND FOETUS FOLLOWING METHOXYFLURANE ANAESTHESIA FOR VAGINAL DELIVERY

SUMMARY The acid-base status and clinical condition of twenty-six healthy mothers and their newborns following uncomplicated spontaneous or low forceps delivery under methoxyflurane-oxygen anaesthesia were studied and the effects of light and deep planes of anaesthesia compared. There were no significant disturbances in the acid-base status of the mother before anaesthesia and at delivery or of the foetus following light as compared with deep anaesthesia. However, the time to sustained respiration increased significantly in the newborns subjected to deeper planes or longer periods of anaesthesia, and the incidence of 1-minute Apgar scores of 7 rose. Methoxyflurane administered to the mother during labour and delivery does not appear to alter the biochemical status of the foetus but does depress the central nervous system subsequent to transplacental passage.

Cystic Fibrosis and Pregnancy

A 19-year-old white woman with cystic fibrosis diagnosed for the first time during her first pregnancy was hospitalized for seven weeks for treatment of pulmonary problems. Three weeks later a normal infant was born, by elective low forceps delivery, after a normal labor. This is the 11th reported case of pregnancy occurring in a patient with cystic fibrosis.

Renal Failure in the Newborn

THIS REPORT DESCRIBES a premature newborn infant with anuria and uremia who was successfully treated with peritoneal dialysis. Most of the reported infants subjected to this procedure were dialyzed to remove poisons 1 or to treat renal failure due to diarrhea with dehydration. 2 Peritoneal dialysis has been reported in only one neonate with renal failure. 3 Possible causes of anuria in the neonate include severe hypoxia, septicemia, circulatory failure, bilateral cortical necrosis, congenital anomalies, and renal vein thrombosis. Report of a Case This 2,440.25 gm (5 lb 6 oz) baby girl was delivered by low forceps after 36 weeks gestation to a 20-year-old primigravida at 4:40 pm on March 28, 1966. During the last trimester of pregnancy the mother gained 31 lb. A low sodium diet and chlorothiazide were prescribed. Just prior to delivery her blood pressure was 130/100 and she showed slight pedal edema. No history of diabetes