Kielland's forceps: association with neonatal morbidity and mortality.
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The incidence of certain neonatal complications associated with the use of Kielland's forceps was analyzed retrospectively in liveborn singleton babies delivered at this hospital between January and December 1976. The neonatal mortality rate attributable to use of the forceps was 34.9 per 1000. The incidences of delayed onset of respiration (17.4%), birth trauma (15.1%), and abnormal neurological behaviour--namely, apathy or irritability or both--(23.3%) significantly exceeded those in a matched group of babies born spontaneously. Fetal asphyxia played a major part in the aetiology of neonatal complications. Babies on whom Kielland's forceps were used, however, had a significantly greater incidence of abnormal neurological behaviour even in the absence of fetal asphyxia (14.3%), and in all of these babies the abnormal behaviour was transient and did not necessitate admission to the special-care baby unit. Neither maternal height nor the infant's birth weight or occipitofrontal head circumference influenced the occurrence of neonatal complications. The results also suggest that neither the speed of cervical dilatation nor the timing of engagement of the fetal head is of help in predicting the occurrence of neonatal complications after the use of Kielland's forceps. (+info)
Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia.
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OBJECTIVES: A major component of the increasing trend in cesarean sections in Western Australia is the rise in emergency cesarean sections in primiparous women. The aim of this study was to identify independent risk factors (particularly those known early in pregnancy) associated with operative delivery in low-risk primiparous women. METHODS: Retrospective multivariate logistic regression analyses of antenatal and perinatal data were conducted for all low-risk primiparous women entering labor spontaneously and giving birth in Western Australia in 1987 (n = 3641). RESULTS: Of the subjects, 58% had a spontaneous vaginal delivery, 8% had an emergency cesarean section, and 34% had an operative vaginal delivery. The significant independent risk factors for emergency cesarean section were older maternal age, shorter maternal height, heavier infant birthweight, and long labor. The risk factors for operative vaginal delivery were older maternal age, shorter maternal height, heavier infant birthweight, epidural anesthesia, labor/delivery complications, male infant, private patient status, and being married. CONCLUSIONS: This multivariate analysis confirms known risk factors for operative delivery in low-risk primiparous women and suggests that it may be possible to predict the likelihood of operative delivery for an individual woman by using knowledge of maternal age and height and assessment of infant birthweight. (+info)
Lumbar epidural analgesia in labour: relation to fetal malposition and instrumental delivery.
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The incidence of instrumental delivery and malposition immediately before delivery was compared in patients who were given lumbar epidural analgesia and those who were not. Instrumental delivery was five times more common and a malposition of the fetal head was more than three times as common in the epidural group as in women who did not receive regional analgesia. Similar incidences were found even when the epidural was electively chosen before labour in the absence of medical indications. The instrumental delivery rate was affected by parity, the length of the second stage of labour, and the return of sensation by the second stage but not by other factors studied. The high incidence (20%) of malposition associated with epidural analgesia was not affected by any of the factors studied. The psychological and physical disadvantages of malposition and instrumental delivery have yet to be assessed. In the meantime, when there are no medical indications for epidural analgesia, the advantages of pain relief should be weighed against those of a normal spontaneous delivery. (+info)
Is permanent congenital facial palsy caused by birth trauma?
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OBJECTIVE: To study the relation between traumatic birth and the development of permanent facial palsy in the newborn. DESIGN: Retrospective case control study of children with 'congenital' facial palsy. SETTING: Two tertiary referral centres for patients with facial palsy. SUBJECTS: 61 children with established facial palsy. MAIN OUTCOME MEASURES: Odds ratios of recognised factors for birth injury: maternal primiparity, high birth weight, and the use of obstetric forceps at delivery. RESULTS: 13.2% of those studied had forceps assisted delivery compared to 10.2% in the normal population (odds ratio 1.34; 95% confidence intervals 0.61 to 2.97) 39.6% were born to primiparae compared to a national rate of 36.7% (1.13; 0.65 to 1.96) and only 18.9% weighed more than 3500 g at birth (0.37; 0.19 to 0.74). CONCLUSIONS: There is no association between the development of permanent 'congenital' facial palsy and recognised risk factors for birth injury. These data suggest an intrauterine rather than a traumatic aetiology. (+info)
Elective forceps delivery and extradural anaesthesia in a primigravida with portal hypertension and oesophageal varices.
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The use of extradural analgesia to avoid straining in a primigravida with portal hypertension and secondary oesophageal varices is described, together with a discussion of the advantages and disadvantages of this approach. (+info)
Are operative delivery procedures in Greece socially conditioned?
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Caesarean section rates have increased in Greece by almost 50% during the last 13 years. We conducted a study in Athens, Greece, to assess the importance of a series of medical and socioeconomic factors in the use of Caesarean section or operative vaginal procedures, rather than a non-operative process, for the delivery of singleton, liveborn babies of primiparous mothers. We used a case control approach to compare 444 babies delivered through a Caesarean section and 130 delivered through operative vaginal delivery with 1235 normally delivered babies in a public and a private hospital. Data were analysed through multiple logistic regression. Caesarean section was more commonly performed in older, shorter or overweight mothers and for high and low birth-weight babies, as well as in response to several obstetric complications and following in-vitro fertilization. A similar pattern was noted with respect to operative vaginal delivery, except that this procedure was not unusually frequent among overweight women and was not encountered in this study among children born after in-vitro fertilization. Caesarean section was performed twice as often in the public teaching hospital as in a private maternity hospital, and operative vaginal delivery was several times more common in the former than in the latter, after controlling for biomedical risk factors. The unequal distribution of operative delivery procedures between the public and the private hospital raises questions about the justification of their performance in a substantial fraction of deliveries, and indicates that social factors condition their use. (+info)
Obstetric practice in the Oxford Record Linkage Study Area 1965-72.
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The secular trends in induction in 111 818 births over eight years in the largely rural areas of Oxfordshire and west Berkshire were analysed. Although the induction rate started to rise only in 1969, the forceps and episiotomy rates had been increasing throughout, but both procedures were always twice as prevalent in induced as in non-induced cases. The proportion of women given an anaesthetic was also consistently higher in induced cases, but that of women with long labours fell considerably over the period. The reduction in stillbirth rate was more apparent in induced than in non-induced births. (+info)
Maternal anthropometry-based screening and pregnancy outcome: a decision analysis.
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OBJECTIVE: To assess the impact of screening and intervention based on maternal height, prepregnancy weight and weight during weeks 16-19 or 24-27 in reducing adverse pregnancy outcomes (IUGR, preterm birth and assisted delivery) in developing country settings. METHODS: Decision analysis based on a recent multicentre WHO collaborative study of maternal anthropometry and pregnancy outcomes and meta-analyses of controlled clinical trials of balanced energy/protein supplementation (for IUGR and preterm birth) and support from caregivers during labour (for assisted delivery). Subjects for the analysis comprised pregnant women from Cali, Colombia (1989, n = 4598); urban and rural Pune, India (1990, n = 4307); and urban and rural Myanmar (1981-82, n = 3542) followed until delivery. RESULTS: Seven to 45% of pregnant women had positive screens, with preventive fractions (PFs) ranging from 0.034 to 0.109 for IUGR, 0.027-0.082 for preterm birth and 0.011-0.105 for assisted delivery. Screening prevention ratios (SPRs = ratios of the number of women treated to the number of cases of adverse outcome prevented) are high in all three study settings for preterm birth and assisted delivery (range 22.8-115.7) and low in settings with a high prevalence of the adverse outcome and high specificity of the anthropometric measure (India for IUGR, range 7.0-8.0). Sensitivity analyses demonstrate a marked linear fall in PF and an exponential rise in the SPR as the relative risk associated with intervention increases (i.e. as the protective benefit of intervention decreases) from 0.60 to 0.95. CONCLUSIONS: A maternal anthropometry-based 'risk approach' is unlikely to result in a major reduction in adverse pregnancy outcomes in developing country settings. For risk-free and inexpensive interventions (e.g. caregiver support during labour), a better strategy would be to forego screening and instead treat all pregnant women. (+info)