Vacuum Extraction Research Articles

Obstetrics injuries during shoulder dystocia in a tertiary perinatal center

ObjectivesThis study will present our results in management of fetal shoulder dystocia with special consideration of maternal and neonatal outcome.Study design.A retrospective study was performed at a university tertiary perinatal center. The study included data of singleton vaginal term deliveries in the period of 15 years (2006–2020). Analized informations include: obstetrics maternal and neonatal data and outcomes. ResultsThis period included 45,687 deliveries with diagnosed shoulder dystocia in 254 (0.7 %) cases in vaginal deliveries. Most of the deliveries were spontaneous births 69.7 %, induced deliveries 30.3 %, 47.2 % primiparas and preexisting or gestational diabetes in 21.7 %. The delivery was managed by vacuum extraction in 13.8 %, mediolateral episiotomy in 48.0 % of births, most of the shoulder dystocia were unilateral anterior, while only two cases were diagnosed as more difficult bilateral and 5 cases were recurrent. 87.4 % cases were resolved by McRobert's maneuver, 7.8 % by Barnum's 3.9 % by Wood's maneuver and one case was managed by Menticoglou and by Bourgoise-Siegemundin maneuver. 4.3 % injuries were classified as OASIS of III/IV degree, early postpartum hemorrhage due in 1.6 %. 54.3 % of newborns were male sex, 61.0 % of newborns had birth weight of above 4000 g (mean 4071 g). Maximal Apgar scores were atributed to 92.5 % in first and to 97.2 % in fifth minute, one case that requaired resuscitation. Clavicle fracture was found in 9.5 %, humerus fracture in 0.4 %, transient form of Duchenne Erb obstetrics brachial palsy was diagnosed in only in 7.5 % newborns, while we have not found any case of permanent brachial palsy. ConclusionsOur results confirmed that strategy of prompt identification of shoulder dystocia accompanied by cessation of axial fetal head traction decrease the risk of brachial plexus strain, injury or tear, while performance of exact obstetrical maneuvers resulted in decanceration of fetal shoulders without permanent obstetrics brachial palsy or cerebral morbidity. We think that our good results corelate with our opinion that the performance of external obstetrical manoeuvres should be done without one minute postpone since efforts should be put in sooner shoulder liberation decreasing the time of fetal hypoxia.

Can We Predict Feto-Maternal Adverse Outcomes of Vacuum Extraction?

Introduction Vacuum extraction (VE) is an important modality in modern obstetrics, yet sometimes results in maternal or neonatal adverse outcomes, which can cause a lifetime disability. We aimed to characterize potential risk factors for adverse outcomes that in retrospect would have led the physician to avoid the procedure. Materials and Methods Retrospective cohort of 3331 singleton pregnancies, ≥34w delivered by VE. 263 deliveries (7.9%) incurred a VE-related feto-maternal adverse outcome, defined as one or more of the following: 3-4th-degree perineal laceration, subgaleal hematoma, intracranial hemorrhage, shoulder dystocia, clavicular fracture, Erb's palsy or fracture of humerus. 3068 deliveries (92.1%) did not have VE-related adverse outcomes. Both groups were compared to determine potential risk factors for VE adverse outcomes. Results Multivariable regression found seven independent risk factors for VE-related feto-maternal adverse outcomes: Nulliparity - with an odds ratio (OR) of 1.82 (95% CI=1.11-2.98, p=0.018), epidural anesthesia (OR 1.99, CI=1.42-2.80, p<0.001), Ventouse-Mityvac (VM) cup (OR 1.86, CI=1.35-2.54, p<0.001), prolonged second stage as indication for VE (OR 1.54, CI=1.11-2.15, p=0.010), cup detachment (OR 1.66, CI=1.18-2.34, p=0.004), increasing procedure duration (OR 1.07 for every additional minute, CI=1.03-1.11, p<0.001) and increasing neonatal birthweight (OR 3.42 for every additional kg, CI=2.33-5.02, p<0.001). Occiput anterior (OA) position was a protective factor (OR 0.62, CI=0.43-0.89, p=0.010). Conclusions VE-related adverse outcomes can be correlated to clinical characteristics, such as nulliparity, epidural anesthesia, VM cup, prolonged second stage as indication for VE, cup detachment, prolonged procedure duration and increasing neonatal weight. OA position was a protective factor. This information may assist medical staff to make an informed decision whether to choose VE or cesarean delivery (CD).

Association Between Obstetric History and Urinary Incontinence in a Cohort of Resistance-Trained Women

PurposeUrinary incontinence has the potential to reduce participation in sport and exercise and diminish athletic performance. The purpose of this study was to explore the association between obstetric history and urinary incontinence in a cohort of resistance-trained women.Patients and MethodsThis international, cross-sectional survey was completed by 1252 women competing in either powerlifting, weightlifting or CrossFit. The Incontinence Severity Index determined the severity of urinary incontinence.ResultsAlmost 43% of the participants experienced urinary incontinence in the threemonths prior to the study. The prevalence of urinary incontinence in this cohort according to mode of birth were: caesarean 42.6%, unassisted vaginal 59.3%, vacuum extraction 58.8%, forceps 60.3%, vaginal and caesarean births 66.2%, forceps and vacuum extraction 73.1%. The prevalence of urinary incontinence in the subgroup of women who had undergone urogenital surgery was 63.6%. Kendall’s tau-b indicated that the correlation between ISI score and the number of births was strong and positive (τ = 0.25, p < 0.001).ConclusionOur results suggest that both the number of births and mode of birth influenced the likelihood of urinary incontinence in resistance-trained women. Women who had experienced only caesarean births had the lowest likelihood of urinary incontinence, while women who had experienced both vaginal and caesarean births had the most severe and second highest likelihood of urinary incontinence. Women who had undergone urogenital surgery continued to experience a high likelihood of urinary incontinence.

Magnitude of birth trauma and its associated factors in South Wollo public hospitals, northeast Ethiopia, August 2021: Institutional-Based Cross-Sectional Study

ObjectiveThe institutional-based cross-sectional study was designed to assess the magnitude of birth trauma and its associated factors in South Wollo, northeast Ethiopia.SettingThis study was conducted in the public hospitals of...

Angle of progression measured using transperineal ultrasound for prediction of uncomplicated operative vaginal delivery: systematic review and meta-analysis.

To determine whether intrapartum transperineal ultrasound measurement of the angle of progression (AoP) during the second stage of labor can predict uncomplicated operative vaginal delivery (OVD) using vacuum or forceps extraction. A systematic search in PubMed, EMBASE, Scopus, Web of Science and Google Scholar was performed from inception to February 2021. Studies assessing the predictive accuracy of AoP, measured using intrapartum transperineal ultrasound, for uncomplicated OVD, defined as successful vaginal delivery within three pulls using forceps or no more than two detachments of the vacuum extractor cup, were included. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Summary receiver-operating-characteristics (ROC) curves, pooled sensitivity and specificity, area under the ROC curve (AUC) and summary likelihood ratios (LRs) were calculated. Seven studies reporting on a total of 782 patients undergoing OVD were included in this systematic review and meta-analysis. Second-stage AoP measured during maternal rest had a pooled sensitivity of 80% (95% CI, 59-92%) and specificity of 89% (95% CI, 76-95%), with a LR+ of 7.3 (95% CI, 3.1-15.8) for uncomplicated OVD. AoP measured during active pushing had a sensitivity of 91% (95% CI, 85-94%) and specificity of 83% (95% CI, 69-92%), with a LR+ of 5.4 (95% CI, 2.7-10.6) for uncomplicated OVD. The performance of AoP measured at rest was particularly high in nulliparous women, with a sensitivity of 87% (95% CI, 75-94%) and specificity of 90% (95% CI, 82-94%) for uncomplicated OVD. AoP may be a reliable predictor for uncomplicated OVD when measured during the second stage of labor, especially in nulliparous women. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal risk factors for a child’s health prior to and during pregnancy (results of long-term cohort monitoring in Vologda region)

The work presents the results of the 26-year monitoring with its focus on children’s health. Pre-school children living in the Vologda region were selected as a research object. The aim was to assess health risks for children caused by certain maternal factors and conditions. The study was accomplished as an intra-cohort analysis of data on 1454 children from five cohorts (born in 1998, 2001, 2004, 2014 and 2020) by calculating a relative risk rate. Negative effects produced by sociodemographic, socioeconomic and environmental conditions as well as maternal harmful occupational factors during pregnancy are significant health risk factors for a child. It is true not only for the neonatal period but also during pre-school years. Such health-related factors as stillbirths in case history, complications of a present pregnancy (up-to-date reproductive technologies being applied to achieve it, eclampsia, multiple pregnancy, dangerous fetus position, prematurity, postmaturity, anemia, edemas, protein in urine) and birth (rapid labor, use of vacuum extraction) do the most severe damage to a child’s health at birth and their influence persists as a child grows. Other significant risk factors that influence children’s health in their pre-school years include diseases of the genitourinary and endocrine systems diagnosed in a mother prior to pregnancy; a mother being single; low incomes; electromagnetic radiation at a place where a family lives; harmful working conditions at a mother’s workplace (gases in workplace air, work on a conveyor belt, radiation exposure). A mother’s young age is also a health risk factor for a fetus during the prenatal period but its influence reduces as a child grows. In contrast, if a mother is older than 40, this factor protects a child’s health during pregnancy but increases likelihood of retarded neuropsychic development by the school age (due to a mother’s low health potential). Overwhelming majority of health risk factors we detected in this study are quite manageable. Our results can be used in creating programs aimed at preserving health of a mother and a child at any level, from individual to national one.

Факторы риска здоровью ребенка со стороны матери до и во время беременности (итоги многолетнего когортного мониторинга в Вологодской области)

The work presents the results of the 26-year monitoring with its focus on children’s health. Pre-school children living in the Vologda region were selected as a research object. The aim was to assess health risks for children caused by certain maternal factors and conditions. The study was accomplished as an intra-cohort analysis of data on 1454 children from five cohorts (born in 1998, 2001, 2004, 2014 and 2020) by calculating a relative risk rate. Negative effects produced by sociodemographic, socioeconomic and environmental conditions as well as maternal harmful occupational factors during pregnancy are significant health risk factors for a child. It is true not only for the neonatal period but also during pre-school years. Such health-related factors as stillbirths in case history, complications of a present pregnancy (up-to-date reproductive technologies being applied to achieve it, eclampsia, multiple pregnancy, dangerous fetus position, prematurity, postmaturity, anemia, edemas, protein in urine) and birth (rapid labor, use of vacuum extraction) do the most severe damage to a child’s health at birth and their influence persists as a child grows. Other significant risk factors that influence children’s health in their pre-school years include diseases of the genitourinary and endocrine systems diagnosed in a mother prior to pregnancy; a mother being single; low incomes; electromagnetic radiation at a place where a family lives; harmful working conditions at a mother’s workplace (gases in workplace air, work on a conveyor belt, radiation exposure). A mother’s young age is also a health risk factor for a fetus during the prenatal period but its influence reduces as a child grows. In contrast, if a mother is older than 40, this factor protects a child’s health during pregnancy but increases likelihood of retarded neuropsychic development by the school age (due to a mother’s low health potential). Overwhelming majority of health risk factors we detected in this study are quite manageable. Our results can be used in creating programs aimed at preserving health of a mother and a child at any level, from individual to national one.

Is there still an indication for episiotomy? Results from a French national database analysis.

To assess the link between mediolateral episiotomy and the occurrence of obstetrical anal sphincter injury (OASIS). Data were collected from the national database (PMSI; Programme de Médicalisation des Systèmes d'Information). Women between 18 and 50 years old, undergoing a vaginal delivery in France in 2018 were included. The main outcome was factors associated with a higher adjusted OASIS rate after a vaginal delivery. Of 623 003 women with a vaginal delivery, 239 949 were primiparous (38.5%), 62 310 experienced mediolateral episiotomy (10.0%) and 7077 had a third- or fourth-degree perineal tear (1.14%). Risk factors for OASIS were primiparity (adjusted odds ratio [OR] 2.97), shoulder dystocia (aOR 2.57), instrumental delivery (aOR 2.81), gestational diabetes (aOR 1.20), and post-term delivery (aOR 1.53). Mediolateral episiotomy increased the occurrence of OASIS for women without an instrumental delivery, either for parous (OR 1.32, 95% confidence interval [CI] 1.07-1.62) or primiparous (OR 1.26, 95% CI 1.13-1.39) women. In contrast, episiotomy among primiparous women with episiotomy and a vacuum or forceps delivery significantly decreased the risk for OASIS (OR 0.62, 95% CI 0.56-0.67). The practice of routine episiotomy should be discouraged. Selective mediolateral episiotomy should be considered with extreme caution and mainly for primiparous women during instrumental vaginal delivery. Further randomized trial may confirm such results.

Trend Changes in the individual contribution of risk factors for postpartum hemorrhage over more than two decades.

Postpartum hemorrhage is an obstetric emergency with a rising incidence. The aim of this study was to identify trends in the specific contribution of various risk factors for postpartum hemorrhage by observing their odds ratios throughout different time periods. In this population-based retrospective cohort study trends of change in odds ratios for known risk factors for postpartum hemorrhage occurring in three consecutive eight-year intervals between 1988 and 2014 were compared. Two multivariable logistic regression models were used in order to identify independent risk factors for postpartum hemorrhage in our population. Trends of various risk factors were compared along the time period of the study. The incidence of postpartum hemorrhage increased from 0.5% to 1988 to 0.6%. Using logistic regression models, preeclampsia, vacuum extraction delivery, retained placenta, perineal or vaginal tears and delivery of a large for gestational age neonate were recognized as independent risk factors for postpartum hemorrhage. While the odds ratios for perineal or vaginal tears significantly increased, odds ratios for delivery of a large for gestational age neonate significantly decreased. Odds ratios for the other risk factors did not change significantly. In our study, not only did the rates of statistically significant risk factors for postpartum hemorrhage change during the study period, the specific contribution of each risk factor changed as well. Having a better understanding of these trends might augment our ability to predict this grave obstetric complication and improve maternal outcomes in the future.

Factors Associated With an Increased Risk of Instrumental Vaginal Delivery in Women With Epidural Analgesia for Labor: A Retrospective Cohort Study

(Eur J Anaesthesiol. 2021;38:1059–1066) Although epidural analgesia is an effective and common method of pain management during labor and delivery, studies suggest there may be an increased risk of instrumental vaginal delivery (IVD, forceps or vacuum extractor) use. Instrumental delivery increases risk of maternal and neonatal morbidity and outcomes. This study aimed to identify women at increased risk of instrumental delivery and strategies to decrease associated maternal and neonatal morbidity.

Factors associated with infection after operative vaginal birth—a secondary analysis of a randomized controlled trial of prophylactic antibiotics for the prevention of infection following operative vaginal birth

A recent randomized controlled trial of prophylactic antibiotics for the prevention of infection following operative vaginal birth showed that women allocated prophylactic intravenous amoxicillin and clavulanic acid had a significantly lower risk of developing confirmed or suspected infection within 6 weeks after operative vaginal birth (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.49-0.69; P < .001). Some international and national guidelines have subsequently been updated to include prophylactic antibiotics after operative vaginal birth. However, the generalizability of the trial results may be limited in settings where the episiotomy rate is lower (89% of women in the trial had an episiotomy). In addition, there was a high burden of infection in the prophylactic antibiotics group despite the administration of prophylactic antibiotics. It is essential to identify modifiable risk factors for infection after operative vaginal birth, including the timing of antibiotic administration. This study aimed to evaluate if the effectiveness of the prophylactic antibiotic in reducing confirmed or suspected infection was independent of perineal trauma, identify risk factors for infection after operative vaginal birth, and investigate variation in efficacy with the timing of antibiotic administration. This study was a secondary analysis of 3225 women with primary outcome data from the prophylactic antibiotics for the prevention of infection following operative vaginal birth randomized controlled trial. Women were divided into subgroups according to the perineal trauma experienced (episiotomy and/or perineal tear). The consistency of the prophylactic antibiotics in preventing infection across the subgroups was assessed using log-binomial regression and the likelihood ratio test. Multivariable log-binomial regression was used to investigate factors associated with infection. The multivariable risk factor model was subsequently fitted to the group of women who received amoxicillin and clavulanic acid to investigate the timing of antibiotic administration. Of the 3225 women included in the secondary analysis, 2144 (66.5%) had an episiotomy alone, 726 (22.5%) had an episiotomy and a tear, 277 (8.6%) had a tear alone, and 78 (2.4%) had neither episiotomy nor tear. Among women who experienced perineal trauma, amoxicillin and clavulanic acid administration was protective against infection in all subgroups compared with placebo with no significant interaction between subgroup and trial allocation (P=.17). Moreover, 2925 women were included in the multivariable risk factor analysis. The following were associated with adjusted risk ratios of infection: episiotomy, 2.94 (95% confidence interval, 1.62-5.31); forceps, 1.37 (95% confidence interval, 1.12-1.69) compared to vacuum extraction; primiparity, 1.34 (95% confidence interval, 1.05-1.70); amoxicillin and clavulanic acid administration, 0.60 (95% confidence interval, 0.51-0.72); body mass index of 25.0 to 29.9 kg/m2, 1.21 (95% confidence interval, 1.00-1.47), and body mass index of ≥30 kg/m2, 1.22 (95% confidence interval, 0.98-1.52) compared to body mass index of <25 kg/m2. Each 15-minute increment between birth and antibiotic administration was associated with a 3% higher risk of infection (adjusted risk ratio, 1.03; 95% confidence interval, 1.01-1.06). Timely prophylactic antibiotics should be administered to all women after operative vaginal birth, irrespective of the type of perineal trauma. The use of episiotomy, forceps birth, primiparity, and overweight were associated with an increased risk of confirmed or suspected infection after operative vaginal birth.

Senam Kegel Sebagai Upaya Mengurangi Nyeri Luka Perineum Pada Ibu Nifas di Klinik Bersalin Pera Simalingkar B Medan Tahun 2022

Tears that occur in the perineum during labor or also called perineal lacerations that occur during labor with procedures such as forceps extraction, vacuum extraction, version extraction, kristeller (push on the uterine fundus) and episiotomy. Birth canal tears always provide bleeding in varying amounts. The source of bleeding can be from the perineum, vagina, cervix, and uterine rupture (uterine rupture). Birth canal tears are often found in childbirth assistance by traditional birth attendants. Delivery assistance by health workers with low risk has mild complications so that it can reduce maternal and perinatal mortality (Manuaba, 2013). Morbidity rates due to perineal lacerations include various infections and diseases that accompany pregnancy, childbirth and the puerperium (Friedman, 2012). High risk/complication is a state of deviation from normal, which directly causes morbidity and mortality for both mother and baby. There are several ways that can be used to prevent the occurrence of perineal tears due to normal delivery, including teaching the mother to often do Kegel exercises. Kegel exercises are exercises to strengthen the pelvic floor muscles before delivery, the goal is to strengthen the pelvic floor muscles, help prevent urinary incontinence problems, and can flex the perineal tissue as the baby's birth canal. So that all mothers should be motivated to move the pelvic floor muscles as little and as often as possible, slowly and quickly in the period approaching labor. The Kegel exercise procedure can be remembered and carried out with activities related to the mother's daily activities. Like when you sit in the bathroom after urinating and this is a relaxed position to contract these muscles, and when you want to sleep and under any circumstances. Doing Kegel exercises regularly can help flex the mother's perineal tissue.

Study on Spacing Regulation and Separation Performance of Nanofiltration Membranes of GO.

Graphene oxide (GO) membranes have attracted significant attention in the field of water processing in recent years due to their unique characteristics. However, few reports focus on both membrane stability and the “trade-off” effect. In this study, a series of aliphatic diamines (1, 2-ethylenediamine, 1, 4-butanediamine, and 1, 6-hexamethylenediamine) of covalent crosslinked GO were used to prepare diamine-modified nanofiltration membranes, BPPO/AX-GO, with adjustable layer spacing using the vacuum extraction–filtration method. Moreover, Ax-GO-modified nanofiltration membranes modified with adipose diamine had higher layer spacing, lower mass-transfer resistance, and better stability. When the number of carbon atoms was 5, the best layer spacing was reached, and when the number of carbon atoms was greater than 4, the modified membrane nanosheets more easily accumulated. With the increase in layer spacing, the water flux of the composite film increased to 26.27 L/m2·h·bar. Meanwhile, adipose diamine crosslinking significantly improved the stability of GO films. The interception sequence of different valence salts in the composite membrane was NaCl > Na2SO4 > MgSO4, and the rejection rate of bivalent salts was higher than that of monovalent salts. The results can provide some experimental basis and research ideas for overcoming the “trade-off” effect of a lamellar GO membrane.

Atypical eclampsia: A case report

Background: Most women with eclampsia have a previous history of preeclampsia (proteinuria and hypertension). However, there has been a paradigm shift in this philosophy. There is evidence that atypical eclampsia can occur even in the absence of proteinuria and hypertension which presents a diagnostic dilemma and challenge for obstetricians and gynecologists. The purpose of this case report is to raise awareness about nonclassical and atypical signs of eclampsia so as to avoid complications Case: A multigravida woman with 39-40 weeks gestational age came to the hospital with signs of labor. On examination, blood pressure was 120/70 mmHg without a history of hypertension during antenatal examination, fetal heart rate was 146-156 beats/minute, cervical dilatation was 7-8 cm, with routine blood results within normal limits and planned for vaginal delivery . When monitoring the patient suddenly had a tonic clonic seizure, a complete blood count was performed, liver, kidney, electrolyte function was within normal limits, and proteinuria was found to be +2. The patient was treated with magnesium sulfate and the baby was delivered by vacuum extraction. This patient was managed appropriately with good outcome Discussion: Atypical eclampsia accounts for about 8% of all cases of eclampsia. Atypical forms of eclampsia have an erratic onset. This experience highlights some of the difficulties in managing atypical cases of eclampsia, namely the erratic onset and unpredictable course of the disease that can interfere with timely diagnosis and treatment and contribute to maternal and fetal morbidity and mortality. While controlling seizures by initiating magnesium sulfate therapy,

Causes and Factors of Cryogenic Extraction Biases on Isotopes of Xylem Water

AbstractCryogenic vacuum extraction (CVE) has been considered as the standard technique for the analysis of plant water stable isotopes in ecohydrological research. Recent studies reported that CVE can introduce significant bias in stable isotope analyses, yet the causes and influencing factors of the CVE‐induced deuterium offsets remain poorly understood. Here, we performed rehydration experiments on plant samples from two species and three organs with two distinct‐isotopic spiking waters. Centrifugation and high‐pressure mechanical squeezing were used to separate sap water and tissue water for stable isotope analyses. Plant waters extracted by CVE differed significantly from reference waters in δ2H, but not in δ18O. The δ2H bias was linearly correlated to the xylem water content, and this relationship is affected significantly by plant organs/species and the isotopic signature of the spiking water. Moreover, the δ2H bias induced by CVE (−8.52 ± 0.90‰) was significantly greater than the δ2H difference between the tissue and sap waters (−3.33 ± 0.76‰) for apple stems possessing similar water contents. Thus, hydrogen‐exchange between plant organics and water, and isotopic heterogeneity within plants both contribute to the negative δ2H bias, but the former is the dominant cause. The multiple factors governing the CVE‐induced δ2H bias, make it difficult to establish a unified bias correction equation. Our results question the usefulness of cryogenic extraction as a standard for plant water extraction.

HUBUNGAN PENGETAHUAN IBU HAMIL TENTANG FAKTOR RESIKO ASFIKSIA PADA NEOANTUS DENGAN PERENCANAAN RUJUKAN PERSALINAN

Asphyxia is a condition in which the baby cannot breathe, thus reducing O2 and increasing CO2 which is bad. Risk factors for the incidence of asphyxia are maternal factors such as his disorder, presence of antepartum bleeding, maternal age less than 20 years or more than 35 years, primiparous and grande multiparous, low socioeconomic, preeclampsia and his disorders. Infant factors, namely respiratory depression due to anesthesia or analgesic drugs given to the mother, intracranial bleeding, congenital abnormalities, premature, postmature, location abnormalities, twins, shoulder dystocia, vacuum extraction, forceps, amniotic fluid mixed with meconium. Placental factors include umbilical cord twisting, short umbilical cord, umbilical cord knot, and umbilical cord prolapse. The purpose of this study was to determine the relationship between knowledge of pregnant women about risk factors for newborn asphyxia with delivery referral planning. This type of research is quantitative analytic with a cross sectional research design. This research was conducted at Puskesmas RI Sidomulyo with a research instrument in the form of a questionnaire. The results showed a relationship between mother's knowledge of risk factors for newborn asphyxia and delivery referral planning with p value = 0.007. This study is expected for midwives in providing midwifery services to pregnant women to provide knowledge about the risk factors for newborn asphyxia so that pregnant women can make a labor referral plan if during the delivery process they experience the risk of newborn asphyxia and the knowledge of pregnant women about risk factors for infant asphyxia. newborns so that they can plan a delivery referral if an emergency case is found in a newborn.

Do doctors preferring forceps encounter more obstetric anal sphincter injuries: A retrospective analysis.

Obstetric anal sphincter injuries (OASIS) is a hospital-acquired injury and can affect a woman's quality of life with problems such as anal incontinence, perineal pain, dyspareunia, mental health, psychosexual issues, and concerns about future childbirth choices. The aim of this study was to determine whether there is a correlation between a doctor's preference for instruments, their individual OASIS rate and whether factors such as their fully dilated caesarean section rate, rate of double instrumental and seniority, influences their individual rate of OASIS. A population-based retrospective cohort study was performed on 1340 term nulliparous women with singleton pregnancies who underwent an instrumental delivery or fully dilated caesarean section. A survey of doctors involved in these deliveries was performed. The risk of OASIS was analysed for maternal age, ethnicity, birth position, level of training and doctor's instrument preference using a generalised linear mixed model. Doctors' instrument preferences were established in two ways: a self-reported survey and data-inferred preference based on the most used instrument per doctor. The OASIS rate for individual doctors was calculated. The overall risk of OASIS is higher for forceps compared to vacuum deliveries. Doctors with a preference for forceps compared to vacuum, correlated with both a lower OASIS rate and a higher fully dilated caesarean section rate. Doctors preferring forceps report a lower OASIS and higher fully dilated caesarean section rate. Doctors preferring vacuum must consider carefully whether forceps should follow if a vacuum fails as OASIS is more likely to occur.

Effect of ultrasound‐assisted vacuum extraction on biological properties and bioactive compounds of mango ( Mangifera indica L.) peel and flesh

Ultrasound treatment under vacuum for 40 min led to an increase in the total phenolic and flavonoid contents of flesh. However, phenolic and flavonoid contents of mango peel were close to their initial values under the same conditions. The highest total phenolic and flavonoid amounts of peel were obtained after 30 min of sonication under atmospheric condition. Similarly, carotenoid contents of peel and flesh reached their maximum values after 30 min of sonication under atmospheric condition. DPPH free radical scavenging activity of peel and flesh increased as the duration of ultrasound treatment under vacuum prolonged, especially for 40 min. Phenolic acids and flavonoids in peel and flesh were determined as 3,4-dihydroxybenzoic acid (9.05–18.51 g/100 g and 0.78–1.16 g/100 g, respectively) and catechin (24.28–66.82 mg/100 g and 3.16–6.61 mg/100 g, respectively). The use of ultrasound during the extraction process improved the bioactive properties of flesh, so the application of sonication in combination with vacuum can be used as an alternative. Practical applications Mango draws attention thanks to its Vitamin C, carotenoid, and phenolic compound content. One of the alternative extraction methods is ultrasound-assisted extraction. Ultrasound-assisted extraction increases yields and eliminates the disadvantages of conventional technologies. The components damaged by heat treatment, especially bioactive components, are effectively extracted at low temperatures.

Otoacoustic Emission Hearing Screening of Newborns In Korle-Bu Teaching Hospital, Ghana

Objectives: The aim of the study was to determine outcomes of new-born hearing screening and identify possible causes of hearing loss in NICU Admissions.Method: The research is a cross sectional study of new born screening conducted on all consenting consecutive new- born who are healthy and seen at the post-delivery ward, and NICU outpatient department of KBTH. Associations or differences in variables were examined using chi-squared test. P-value ≤0.05 was considered statistically significant.Results: A total of 483 babies were screened during the period. The incidence of hearing loss in the new-born was 7.2%. More than half of the new-born were 4 weeks or less weeks (n=254, 52.6%) and the rest were greater than 4 weeks (n=229, 47.4%). The mean age (±SD) of the new-born are 3.94 (±2.09) and 3.80 (±2.16) weeks in the admitted and not admitted group respectively. It was revealed that 27% of the babies were admitted at Neonatal Intensive Care Unit (NICU) because of prematurity and Macrosomia (from diabetic mothers) respectively. Among the babies that were admitted, 7 failed the OAE and 101 passed. In the not admitted group, 28 failed OAE test and the rest passed (n=347). This study revealed that, there was no statistically significant association of hearing loss between babies admitted to NICU and Non-NICU babies (p= 0.728).Conclusions: The incidence of hearing loss among the new-born was 7.2% and the main reason for NICU admission are prematurity, big baby, Birth asphyxia, neonatal jaundice, neonatal sepsis, small baby and vacuum delivery. There is no statistically significantassociation between these different group babies with hearing loss.

Perinatal Risk Factors Associated With Intrapartum Perineal Injuries At The Korle Bu Teaching Hospital

Background: Obstetric perineal injury is a major contributor to women’s reproductive health problems. More than 60% of women suffer varying degrees of obstetric perineal injuries during vaginal delivery requiring repair. This study determined the risk factorsassociated with perineal injury. Method: Prospective observational study of 356 women who had singleton term vaginal delivery between 1stApril and 31stMay, 2018 at the KBTH. Sociodemographic and clinical data of participants were collected and analysed to determine association betweenvariables. A p-value of &lt;0.05 was considered statistically significant.Results: Two hundred and thirty-six women (66.29%) had vaginal deliveries with no perineal injuries comprising 81 primiparous and 155 multiparous women. Perineal injury among the study participants were 120/356 (33.71%) while perineal injury for first degree, second degree, third degree and fourth degree were 75/356 (21.07%), 41/356 (11.52%), 2/356 (0.56%), 2/356 (0.56%) respectively. A total of 948 vaginal deliveries was conducted during the study period. The odds of developing a perineal injury was 8 times higher among participants with previous surgery on genital tract (OR, 8.29 [95% CI 2.69- 25.6]; p&lt;0.001) and 18 times higher among participants with previous postpartum complication (OR, 18.00 [95% CI 4.06-79.71], p&lt;0.001). Babies with birth weights ≥2.5kg had 4.11 increased odds of developing perineal injury when compared to those with birth weights &lt;2.5kg (OR, 4.11 [95% CI, 1.70-9.98] p=0.001). Vacuum delivery was strongly associated with a 4.81 odds perineal injury (OR, 4.81 [95% CI, 1.22-18.9] p&lt;0.014).Conclusion: The incidence of perineal injury among women who had vaginal delivery at the KBTH maternity during the study period of (12.66%) was high compared to other studies from the West African Subregion. Risk factors such as previous postpartum complication, episiotomy, and gestational age at delivery, head circumference of the baby, asthma, hypertension and past genital tract surgery weresignificantly associated with perineal injury. Early identification of women at risk of perineal injury could help with interventions to reduce the incidence of this complication during childbirth.