Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

Ayala-Yáñez, Rodrigo; Bayona-Soriano, Paulette; Hernández-Jimenez, Arturo; Contreras-Rendón, Alejandra; Chabat-Manzanera, Paulina; Nevarez-Bernal, Roberto

doi:10.1155/2015/489267

Cited by 8 publications

(6 citation statements)

References 22 publications

(26 reference statements)

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“…The incidence of forceps delivery in the study by Ayala-Yáñez et al 10 is 2.55%, Werner et al 11 is 2.1% in 2003, which is comparable to our study.…”

Section: Incidence Of Outlet Forceps Deliveriessupporting

confidence: 89%

Outlet Forceps Delivery: Role in Modern Obstetric Practice

Jaiswal¹,

Agrawal²,

Dora³

2018

Journal of South Asian Federation of Obstetrics and Gynaecology

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Aim:The dramatic rise of cesarean section rate is a global problem. The forceps delivery has also led to numerous litigations due to poor fetal and sometimes maternal outcome. Still, it is having a prominent role to reduce the rate of cesarean section deliveries. The aim of this study was to assess feto maternal outcome in outlet forceps delivery.Methods: A prospective cohort study of 92 patients who delivered by outlet forceps conducted in the department of obstetrics and gynecology,

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“…The incidence of forceps delivery in the study by Ayala-Yáñez et al 10 is 2.55%, Werner et al 11 is 2.1% in 2003, which is comparable to our study.…”

Section: Incidence Of Outlet Forceps Deliveriessupporting

confidence: 89%

Outlet Forceps Delivery: Role in Modern Obstetric Practice

Jaiswal¹,

Agrawal²,

Dora³

2018

Journal of South Asian Federation of Obstetrics and Gynaecology

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“…Assisted vaginal delivery is an evidence‐based obstetric procedure and when performed for appropriate indications and according to protocol can reduce maternal and fetal morbidity and mortality, reduce short‐term and long‐term risks associated with caesarean delivery, and reduce healthcare costs. Some LMICs already face acute financial crises associated with high caesarean rates and are proposing an increase in AVD as a path to mitigating rising caesarean rates …”

Section: Discussionmentioning

confidence: 99%

“…A limited review of the emergency obstetric care signal functions in 2006 indicated that AVD was the signal function least likely to have been performed across several global regions . A small number of papers mostly describing single‐facility experiences with AVD has emerged from different regions, the majority of papers calling for greater use of these instruments …”

Section: Introductionmentioning

confidence: 99%

Assisted vaginal delivery in low and middle income countries: an overview

Roosmalen

Mola

et al. 2017

BJOG

122

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This study, accomplished with the use of a variety of data sources from health care facilities in a number of developing countries, demonstrates quite clearly the overall relatively low use of assisted vaginal delivery (AVD, obstetrical forceps and the vacuum extractor) in most of the facilities. The information available to the investigators did not allow an assessment of the comparative risks and benefits of AVD in these settings. Not surprising was that factors responsible for the low use of AVD were low availability of equipment and scarcity of adequately trained personnel, which varied in degree among the facilities studied. Also not unexpected was that the use of forceps delivery was much less common than assisted delivery with a vacuum extractor. Even in facilities in developed countries the rate of forceps deliveries has declined over the past three decades, with a concomitant increase in the use of the vacuum extractor (Patel et al. BMJ 2004;328:1302-5). This has occurred despite the fact that forceps deliveries are associated with fewer failures than vacuum extraction and that in cases of fetal distress, delivery can be accomplished more rapidly with forceps than with vacuum extraction. Of course, part, if not all, of the explanation for the declining use of forceps for AVD is that teaching and learning the skillful and safe use of forceps is far more difficult than learning the safe use of the vacuum extractor. This difficulty is augmented by the rise of caesarean delivery as an alternative for an attempted AVD and the decline in the number of practitioners who have sufficient experience using obstetrics forceps to be efficient teachers of the necessary skills using these instruments. Also, safe forceps delivery relies on an adequate knowledge of pelvic anatomy and a familiarity with the pros and cons of several types of forceps, neither of which is a requisite with the vacuum extractor. Evidence of this conundrum is a recent study of 5 years of deliveries (n = 5375) in an obstetric service in Mexico City in which there were only 146 forceps deliveries (i.e. approximately 29 per year) (Ayala-Y a~ nez et al. J Pregnancy 2015:489 267). Although this institution was not described as a training centre for physicians or nurse midwives, it nevertheless shows how few opportunities are available to train young practitioners in the use of forceps. Although the vacuum extractor is a reliable choice for AVD in most cases, it is of no use in a vaginal breech delivery. If spontaneous delivery of the after-coming head does not occur, the only safe alternative is the use of forceps (in most cases the Piper forceps). One of the most important conclusions of the authors of this study is the need for more comprehensive and reliable data collection in obstet-ric facilities in underdeveloped countries. This would allow an assessment of benefits and risks of AVD in these settings and a better estimate of where resources could most efficiently be directed to meet the need for more and better equipment and more trained pers...

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“…This paper describes an experience reintroducing vacuum extraction into a context where it was rarely practiced. Vacuum extraction was reintroduced not as a reaction to rising costs due to soaring caesarean delivery rates as it has been in several Latin American hospitals [ 17 , 18 ], but motivated by providing evidence-based care and preventing highly interventionist strategies that sometimes lose focus of a woman’s well-being, the physical and mental hardships related to recovery from surgery, future pregnancy risks, and the financial costs to families and the health system.…”

Section: Discussionmentioning

confidence: 99%

Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania

Dominico¹,

Bailey²,

Mwakatundu³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundIn rural Tanzania access to emergency obstetric and newborn care is threatened by poor roads and understaffed facilities among other challenges. Districts in Kigoma, Pwani and Morogoro regions were targeted by a local non-governmental organization to assist local government to build capacity and improve access to clinical management of severe obstetric and newborn complications. The program upgraded ten primary health care centres to provide comprehensive emergency obstetric and newborn care. This paper describes the process of reintroducing vacuum extraction into ten health centres and five hospitals, highlighting patterns in uptake, mode of delivery and lessons learned.MethodsThis observational study uses facility-based trend data collected between 2011 and 2016.Descriptive outcomes include institutional caesarean delivery rates, vacuum extraction rates, and the ratio of caesareans to vacuum-assisted deliveries.ResultsInstitutional caesarean delivery rates remained stable at about 10–11% and the vacuum extraction rate rose from virtually no procedures in 2011 to about 2% in 2016. The increase was more visible in upgraded health centres than in hospitals. In 2016 vacuum extraction rates in newly upgraded health centres ranged from 0.5 to 7.8%. Between 2011 and 2016, the ratio of caesareans to vacuum extractions in hospitals changed from 304 caesareans to 1 vacuum extraction to 10:1, while in health centres the ratio changed from 22: 1 to 3: 1.ConclusionsReintroduction of vacuum extraction into clinical practice in primary health care facilities with task-shifting is feasible. Reintroduction of this procedure was more successful when part of an integrated upgrading of health centres to provide comprehensive emergency obstetric care than when reintroduced into busy hospital environments. Turnover of trained staff in hospitals contributed to the uneven uptake of vacuum extraction. Lessons learned are applicable to further national scale up and to other countries.

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Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

Cited by 8 publications

References 22 publications

Outlet Forceps Delivery: Role in Modern Obstetric Practice

Outlet Forceps Delivery: Role in Modern Obstetric Practice

Assisted vaginal delivery in low and middle income countries: an overview

Reintroducing vacuum extraction in primary health care facilities: a case study from Tanzania

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