Instruments for assisted vaginal birth

Verma, G.; Spalding, Jessica J; Wilkinson, Marc D.; Hofmeyr, G Justus; Vannevel, Valerie; O’Mahony, Fidelma

doi:10.1002/14651858.cd005455.pub3

Cited by 16 publications

(24 citation statements)

References 62 publications

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“…Our study contradicts the notion that increasing one's ability to perform complex forceps may decrease the caesarean section rate. Our findings are supported by a systematic review which found a trend toward more caesarean sections with forceps, which was not statistically significant (relative risk 1.76) and fewer caesarean sections when the initial instrument was the vacuum 12 . Our findings are comparable to a retrospective study which identified a lower IRO in doctors who preferred forceps 13 .…”

Section: Discussionsupporting

confidence: 78%

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

Nagi

Karantanis

Mallitt

2022

Aust NZ J Obst Gynaeco

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Background 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. Aims 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. Materials and methods 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. Results 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. Conclusions 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.

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Section: Discussionsupporting

confidence: 78%

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

Nagi

Karantanis

Mallitt

2022

Aust NZ J Obst Gynaeco

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“…LAM avulsion produces an alteration in the support of the pelvic floor structures, however this fact should not influence the decision to implement a delivery. In fact, a recent Cochrane review establishes that there is no instrumentation that guarantees maternal and fetal safety [49]. However, instrumentation at delivery will depend on the skill of the operator, the selection of available instruments, and the clinical setting [49].…”

Section: Fig 3 Analysis Of the General Levator Ani Muscle (Lam) Avuls...mentioning

confidence: 99%

“…In fact, a recent Cochrane review establishes that there is no instrumentation that guarantees maternal and fetal safety [49]. However, instrumentation at delivery will depend on the skill of the operator, the selection of available instruments, and the clinical setting [49].…”

Section: Fig 3 Analysis Of the General Levator Ani Muscle (Lam) Avuls...mentioning

confidence: 99%

Diagnosis of Levator Ani Muscle Avulsion in Instrumented Delivery: Meta-analysis

García‐Mejido¹,

Fernández‐Palacín²,

Lao-Peña³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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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.

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“…Compared with forceps delivery, VE is more commonly used because of its ease of application and low incidence of maternal trauma. Forceps delivery is more likely to achieve vaginal birth with decreased fetal trauma but has a greater risk of perineal trauma and higher pain relief requirement 1 . In Hong Kong, one study reported that the decreasing instrumental delivery rates were associated with an increase in secondstage caesarean section and a higher failed instrumental delivery rate 2 .…”

Section: Vacuum Extraction and Subgaleal Haemorrhagementioning

confidence: 99%

Association between vacuum extraction and subgaleal haemorrhage: can intrapartum ultrasound reduce the risks?

Kong

2022

Hong Kong Journal of Gynaecology, Obstetrics and Midwifery

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Vacuum extraction is a common procedure in the labour ward. Subgaleal haemorrhage is a rare neonatal complication that can be life threatening. We examine the risk factors associated with subgaleal haemorrhage after vacuum extraction, including fetal head malposition and inappropriate cup placement, and the role of intrapartum ultrasound in reducing perinatal complications. Although there is an increasing trend for using intrapartum ultrasound for more precise diagnosis of fetal head position, there is no evidence that this practice reduces failed vacuum delivery rates or perinatal morbidity.

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Instruments for assisted vaginal birth

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 16 publications

References 62 publications

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

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

Diagnosis of Levator Ani Muscle Avulsion in Instrumented Delivery: Meta-analysis

Association between vacuum extraction and subgaleal haemorrhage: can intrapartum ultrasound reduce the risks?

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