A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps

Bueno, José Antonio Sainz; García‐Mejido, José Antonio; Aquise, Adriana; Borrero, Carlota; Bonomi, Maria; Fernández-Palacín, Ana

doi:10.1016/j.ajog.2018.10.035

Cited by 51 publications

(29 citation statements)

References 47 publications

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“…Fetal head station was assessed (low instrumentation [vertex at +2 station] and mid‐cavity instrumentation [head is engaged but leading part above +2 station]) according to the criteria specified by the ACOG . Fetal head position was determined by transabdominal ultrasound (anterior, posterior, and transverse) . In cases of disengagement, forceps branches were disengaged and removed when expulsion was certain but before the widest diameter of the fetal head had passed through the introitus (Figures and ).…”

Section: Methodsmentioning

confidence: 99%

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Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Bueno

Martín‐Martinez

González-Díaz

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Forceps use is the main risk factor for levator ani muscle (LAM) injuries. We believe that the disengagement of the forceps branches before delivery of the fetal head could influence LAM injuries, so we aimed to determine the influence of the disengagement of the forceps on the occurrence of LAM avulsion during forceps delivery. Material and methods A prospective, observational, multicenter study was conducted with 261 women who underwent forceps delivery. The women were classified according to whether the branches of the forceps had been disengaged before delivery of the fetal head. LAM avulsion was defined using a multislice mode (3 central slices). Results In all, 255 women completed the study (160 without disengagement and 95 with disengagement). LAM avulsions were observed in 37.9% of women in the group with disengagement and in 41.9% of women in the group without disengagement. The crude OR (without disengagement vs with disengagement) for avulsion was 0.90 (95% CI 0.49‐1.67, P = 0.757) and an adjusted OR of 0.82 (95% CI 0.40‐1.69, P = 0.603). Conclusions We did not observe a statistically significant reduction in the LAM avulsion rate with disengagement of the forceps branches before delivery of the fetal head.

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Section: Methodsmentioning

confidence: 99%

“…head position was determined by transabdominal ultrasound (anterior, posterior, and transverse). 12 In cases of disengagement, forceps branches were disengaged and removed when expulsion was certain but before the widest diameter of the fetal head had passed through the introitus 9 (Figures 1 and 2).…”

Section: Key Messagementioning

confidence: 99%

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Bueno

Martín‐Martinez

González-Díaz

et al. 2019

Acta Obstet Gynecol Scand

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“…However, it should be borne in mind that the studies comparing both types of instrumental delivery, and their relation to LAM trauma, have not considered the conditions under which each instrument was applied, and thus, we believe their findings might be incomplete. In this study, as previously, we evaluated the use of each instrument whilst taking into account potential confounding factors of different instrumental techniques and found no statistically significant difference in the LAM avulsion rate between the techniques. However, in this study we included only Malmström vacuum extractor and Kielland forceps, which may explain why we found a higher avulsion rate after vacuum delivery as compared to that in other studies.…”

Section: Discussionmentioning

confidence: 57%

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

García‐Mejido

Martín‐Martinez

González-Díaz

et al. 2020

Ultrasound in Obstet & Gyne

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Objective To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. Methods This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. Results In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36–3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95–4.85); P = 0.068). Conclusion When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…In particular, TPU offers an objective, accurate and reproducible method for the evaluation of fetal head engagement [13][14][15][16][17][18][19] . The angle of progression (AoP) is one of the most reproducible and studied TPU indices of fetal head station and engagement 15,[23][24][25][26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

Youssef

Brunelli

Montaguti

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. Methods This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. Results In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean‐delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). Conclusions Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

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A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps

Cited by 51 publications

References 47 publications

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Influence of the disengagement of the forceps on levator ani muscle injuries in instrumental delivery: A multicenter study

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement

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