Vacuum Extraction Research Articles

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.

Green Synthesis of Sodium Cyanide Using Hydrogen Cyanide Extracted under Vacuum from Cassava (Manihot esculenta Crantz) Leaves

This study was carried out to develop a green approach to synthesising sodium cyanide (NaCN) using hydrogen cyanide (HCN) extracted from cassava (Manihot esculenta Crantz) leaves after 120 min of maceration at 30 °C and 45 min of recovery under vacuum at 35–40 °C. The CN- ion released via autolysis was reacted with the Na+ ion following vacuum extraction of the former to produce NaCN by saturating the absorbing sodium hydroxide (NaOH) solution. This specific extraction method avoided direct contact between the cassava leaves homogenate and the absorbing solution. NaCN was crystallised by drying the NaCN slurry at 100 °C in an air oven. A total of 15.70 kg of fresh cassava leaves was needed to produce 32.356 g of NaCN (green-NaCN) (% NaCN yield = 0.21%). The results of X-ray diffraction, attenuated total reflectance–Fourier transform infrared spectroscopy and scanning electron microscopy with energy-dispersive X-ray spectroscopy, show that NaCN was successfully prepared using the proposed method. These spectral techniques showed that the control and green-NaCN contained sodium carbonate impurities. The latter was quantified by the titration experiments and was found to be 0.61% and 2.29% in the control and green-NaCN, respectively. Furthermore, the titration experiments revealed that the residual NaOH content was 1.63% in control NaCN and 4.68% in green-NaCN. The aim of modifying the green synthesis route for producing NaCN from cassava, developed by the Attahdaniel research group in 2013 and 2020, was achieved.

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.

Concealed Uterine Rupture in the Broad Ligament in an Unscarred Uterus With Postpartum Hemorrhage

Uterine rupture is an obstetric emergency that traditionally occurs during delivery in a mother with previously known risk factors, especially a uterine scar. However, a rupture that occurs in an unscarred uterus is uncommon. We report a case of a low-risk mother who presented for induction of labor for late-term pregnancy, without a history of uterine surgery, required vacuum-assisted vaginal delivery for maternal exhaustion, and one hour later was noted to have postpartum hemorrhage. The postpartum hemorrhage was managed medically but was taken for curettage due to continued hemorrhage and hemodynamic instability, followed by laparotomy which identified an 11 cm vertical uterine rupture parallel to the ascending uterine artery concealed in the broad ligament and extending inferiorly to the lateral cervix, necessitating a total abdominal hysterectomy. The patient tolerated the procedures well and was discharged home on postoperative day 2. Highlighting the importance of a high index of suspicion for uterine rupture, even without risk factors, this report describes an atypical presentation and describes an effective stepwise approach to management.

A Rare Cause of Fever in a Term Neonate.

A Rare Cause of Fever in a Term Neonate.

Charité Caesarean Birth Improves Birth Experience in Planned and Unplanned Caesarean Sections While Maintaining Maternal and Neonatal Safety: A Prospective Cohort Study

Background: In this study, we aimed to assess the safety of a modified caesarean delivery (Charité caesarean birth) in an extended frame of indications, and to examine its impact on parents’ birth experience and long-term effects. Methods: This prospective cohort study was performed from January to June 2019. A standardized questionnaire was given to all women who gave birth as an inpatient delivery. Eight months after hospital discharge, all women who gave consent were sent a follow-up questionnaire including questions on current feelings, breast feeding, bonding, and support system, as well as a screening for postnatal depression. Indications for caesarean delivery included preterm birth, fetal malpresentation, fetal malformation, twin pregnancy, and maternal pre-existing conditions. Results: The study cohort included 110 women. The mode of delivery was spontaneous in 49%, per vacuum extraction in 15%, conventional caesarean section in 7%, and Charité caesarean birth in 29%. The groups with Charité versus conventional caesarean delivery did not significantly differ in neonatal admission rates, umbilical cord parameters, maternal blood loss, or duration of surgery. Compared to conventional caesarean delivery, women who underwent a Charité caesarean delivery were significantly more satisfied with their birth experience. At follow-up, the mode of delivery was not associated with significant differences in postnatal depression, breast feeding, or bonding parameters. Conclusions: Outside of emergency situations, Charité caesarean birth improves patients’ well-being, without increased maternal and neonatal morbidity.

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.

A case of unscarred uterine rupture complicated by bladder rupture after vacuum extraction delivery

A case of unscarred uterine rupture complicated by bladder rupture after vacuum extraction delivery

Spatially dependent salinity effect in actively vacuumed spray flash desalination

Spray flash desalination is one of the most promised distillation methods, which is realized by spraying the superheated droplets into a depressurized chamber to generate flash evaporation. This intensive evaporation leads to a strongly temperature-salinity coupled polarization near the surface region within droplets, which in turn reduces the evaporation rate. In a spray flash desalination chamber with active vacuuming of vapor extraction, such internal polarizations also weaken the thermal non-equilibrium between the extracted hot vapor and the discharged cooler feed residue during the process. This paper aims to establish an integrated modeling-experiment-CFD methodology for quantifying the spatially dependent salinity effect within droplets to the overall processing characteristics in an actively vacuumed spray flash desalination, such as the evaporation rate and efficiency, the coupled internal heat conduction and salt diffusion within droplets, the thermal non-equilibrium between vapor and spray, as well as the non-uniformed vapor flow from vacuum extraction. Specifically: the heat conduction and salt diffusion coupled droplet flash model is proposed; a further simplified point-based droplet flash model is established for CFD simulations; an experimental system of spray flash desalination with active vacuuming is developed for model validations. The evaporation rate and the thermal non-equilibrium are found to be positively related to the initial superheat levels of the spray but negatively impacted by the initial salinity. Modeling predictions indicate that ignoring the spatial dependence of salinity can over-estimate the flash rate by up to 30% in high salinity cases of salty-water distillation. The thermal non-equilibrium between vapor and feed can be effectively generated under active vacuum, even with a low initial superheat level and high salinity. Increasing feed salinity from 0% to 10% in different cases will narrow the temperature gap between outlet vapor and feed residue by about 10% on average. For typical industrial flash desalination (with salinity up to 10%), with or without considering the spatial dependence of salinity will cause relatively minor differences (less than 5%) on the prediction of evaporation rate.

Compliance with clinical guidelines increases the safety of vacuum-assisted delivery.

Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P= 0.0002), major birth trauma (3% vs 22%, P= 0.0001), requirement for neonatal resuscitation (14% vs 35%, P= 0.0026) and Apgar scores at oneminute less than six (5% vs 22% P= 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P= 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P= 0.02) and birth requiring instrument change (4% vs 13% P= 0.031). Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.

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.

Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor.

To determine the validity of intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor. Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3h ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descent, measured by AOP change/h (calculated from serial measurements), was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent. Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153° ± 19 vs. 133° ± 17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127° was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1° ± 11.4° vs. 6.2° ± 6.3°, p < 0.001). Ultrasound-assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting the mode and interval time to delivery in real-life clinical practice.

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.

Using choline nitrate as solvent and oxidant in direct oxidation of organic halides and alcohols to aldehyde and its derivatives

Choline nitrate is prepared by the anion exchange of choline chloride and sodium nitrate. Also, choline chloride gives a low melting point mixture in the presence of aluminum nitrate. The use of choline nitrate as a safe and environmentally friendly solvent and reactant provides an efficient procedure, simple and mild for oxidizing alcohols and organic halides to aldehydes. Aldehydes using choline nitrate and trimethylsilyl chloride mixture as a selective oxidant and without using catalysts were synthesized from alcohols and the relevant halides. Benzyl chloride in the presence of choline nitrate and trimethylsilyl chloride at 70 °C produced the corresponding aldehyde product with 87% efficiency, while benzyl alcohol at 50 °C with 90% efficiency performed this conversion.The prepared aldehyde is easily separated from the reaction medium by vacuum distillation or extraction by organic solvent without the need for further purification.

Anal incontinence after a prolonged second stage of labor in primiparous women.

The objective was to investigate the effect of delivery mode on anal incontinence 1–2 years after delivery in primiparous women with prolonged second stage of labor. This population-based cohort and questionnaire study performed in Stockholm Region, Sweden, included 1302 primiparous women with a second stage ≥ 3 h from December 1st, 2017 through November 30th, 2018. Background characteristics and outcome data were retrieved from computerized records. Questionnaires based on Wexner score were distributed 1–2 years after delivery. Risk of anal incontinence, defined as Wexner score ≥ 2, was calculated using logistic regression and presented as crude and adjusted odds ratios (OR and aOR) with 95% confidence intervals (CI). Compared with cesarean section, vacuum extraction was associated with anal incontinence (aOR 2.25, 95% CI 1.21–4.18) while spontaneous delivery was not (aOR 1.55, 95% CI 0.85–2.84). Anal incontinence was independently associated with obstetric anal sphincter injuries (aOR 2.03, 95% CI 1.17–3.5) and 2nd degree perineal tears (aOR 1.36, 95% CI 1.03–1.81) compared with no or 1st degree perineal tear. Obstetric anal sphincter injury at vacuum extraction inferred the highest risk of anal incontinence (aOR 4.06, 95% CI 1.80–9.14), compared with cesarean section. Increasing duration of the prolonged second stage did not affect the risk.

Associations Between Maternal Trauma Rates in Spontaneous Vaginal, Attempted Forceps, and Attempted Vacuum Deliveries in Canadian Hospitals

Comparative statistics routinely published by the Organization for Economic Cooperation and Development have regularly characterized Canadian rates of maternal trauma as being the highest among member countries both among spontaneous vaginal deliveries (SVDs) and among operative vaginal deliveries (OVDs). We sought to quantify the associations between hospital-level rates of maternal trauma among SVDs and OVDs.

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.

Analisis Faktor Risiko Persalinan dengan Tindakan di Lebak Banten

&lt;p&gt;The maternal mortality rate (MMR) increased from 2007 to 2012. However, based on the 2015 Inter-Censal Population Survey (SUPAS) was decreased. The causes include pregnancy, delivery, and puerperal. The purpose of this study was to analyze delivery risk factors in Lebak Banten in 2019. The cross-sectional study design and data collection were carried out using a questionnaire by interview. The research sample consisted of 120 women of childbearing age who had given birth in Sangiangtanjung Village, Kalanganyar District, Lebak Regency, Banten, and were selected by purposive sampling technique. The variables consisted of delivery methods and 11 independent variables including age, education, occupation, socio-economic, infectious diseases, chronic diseases, hypertension, the danger of pregnancy, the danger of delivery, premature rupture of membranes, and fetal location which were analyzed using multiple logistic regression to determine which variable is most at risk for delivery. It was found that most mothers gave birth normally (90.8%). The remainder performed delivery with measures consisting of vacuum (0.8%) and cesarean delivery (8.4%). The results also showed that women who suffer from hypertension will give birth 7 times greater (95% CI 1.2-39.6) than mothers who do not have hypertension after being controlled by maternal education, chronic disease, and fetal location. There were only one of eleven factors was hypertension which is a risk factor for operative delivery in Lebak Banten. Therefore, it is necessary to promote health to pregnant women to prevent the occurrence of hypertension by health workers to reduce the impact.&lt;/p&gt;

Isotopic deviations of water extracted from carbonate soil by cryogenic vacuum extraction: implication for root water uptake analysis

Isotopic deviations of water extracted from carbonate soil by cryogenic vacuum extraction: implication for root water uptake analysis

Caesarean section, vaginal instrumental delivery and perineal morbidity in the Slovak Republic in the years 2007-2018.

Analysis of caesarean section, vaginal instrumental deliveries and severe perineal morbidity in the Slovak Republic in the years 2007-2018. The analysis of prospectively collected caesarean section and vaginal instrumental delivery data in the years 2007-2018, and episiotomies and severe perineal morbidity data in the years 2008-2018 from obstetrics hospitals in the Slovak Republic. Caesarean section rate progressively increased from 24.1% in 2007 up to 30.8% in 2013 and decreased to 29.6% in 2018. Vacuum-extraction frequency was 1.3% in 2007 and increased up to 2.0% till 2018. Forceps frequency decreased since 2008-2018 from 0.56% to 0.43%. In the years 2008-2018, frequency of perineal tears of the 3rd and 4th degree increased from 0.4% to 0.8%. Frequency of episiotomies decreased in the years 2008-2018 from 74.7% to 47.7%. The highest caesarean section rate in the Slovak Republic - 30.8% occurred in 2013, but slowly decreased in the following years. The frequency of vacuum extraction increased and forceps decreased. Frequency of episiotomies had decreased and severe perineal tears held an increasing trend.