Obstetric forceps were invented in the 1600s to assist vaginal delivery of term babies following prolonged labour. This probably explains their design, with a narrow interblade distance and long blade length, to fit a severely moulded fetal head. However, in modern obstetric practice protracted labour is avoided, yet our research has shown that over 400 years forceps dimensions have remained largely unchanged. We believe it is time to optimise these dimensions based on biometry of the term, newborn baby's head, with the head width (biparietal diameter) and head length (mentovertical diameter) correlating with interblade distance and blade length respectively. We hypothesise that doing so should reduce the incidence of neonatal complications associated with forceps assisted delivery and it is also possible that the amended shape might be associated with better outcomes for women. In this article we present our rationale for the optimisation of the forceps dimensions based on the findings of our previous systematic review and an original series of mentovertical and biparietal diameter measurements using laser scanning technology.
- Klíčová slova
- Biparietal diameter, Laser scanner, Mentovertical diameter, Obstetric forceps,
- MeSH
- biometrie MeSH
- hlava diagnostické zobrazování MeSH
- lidé MeSH
- novorozenec MeSH
- porodní děj * MeSH
- porodnické kleště * škodlivé účinky MeSH
- těhotenství MeSH
- vedení porodu MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis. DESIGN: Prospective case-control study analysis. SETTING: Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed. RESULTS: In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%). CONCLUSION: The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.
- Klíčová slova
- cephalohematoma, forceps delivery, maternal trauma, neonatal trauma, vacuum-assisted delivery,
- MeSH
- hematom etiologie MeSH
- lacerace etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- porodní poranění novorozence etiologie MeSH
- porodnické kleště škodlivé účinky MeSH
- prospektivní studie MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- vakuová extrakce porodnická škodlivé účinky MeSH
- vedení porodu metody MeSH
- výsledek těhotenství MeSH
- ženské pohlavní orgány zranění MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: This article is meant to be a complement to the new statement "Assisted vaginal delivery" of the Section of perinatal and fetomaternal medicine (SPFM) of the Czech Society of Gynecology and Obstetrics ČLS JEP, which is also published in this issue of Czech gynecology. The new statement has been formed as a synthesis of two previous separate statements of the SPFM "Vacuumextraction" and "Forceps delivery" and has also been updated based on new scientific knowledge. This review publication summarizes latest knowledge on vacuumextraction and forceps delivery and adds comments to certain points from the statement. DESIGN: A review of the literature.
- Klíčová slova
- assisted vaginal delivery, complications., forceps, indications, vacuumextraction,
- MeSH
- extrakce porodnická metody MeSH
- gynekologie MeSH
- lidé MeSH
- novorozenec MeSH
- porodnické kleště * MeSH
- společnosti lékařské MeSH
- těhotenství MeSH
- vakuová extrakce porodnická * MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To analyze trends in vaginal assisted deliveries between 2002-2011 in the Moravian-Silesian region, Czech Republic. DESIGN: Retrospective analysis. SETTING: Obstetric facilities in the Moravian-Silesian region, Czech Republic. METHODS: Analysis of data on vaginal assisted deliveries in the obstetric facilities in the Moravian-Silesian region, Czech Republic, between the years 2002-2011. RESULTS: During the analyzed period the use of vacuum extraction rose from 0.11% to 2.44% of all deliveries and the use of forceps declined from 1.54% to 0.24% of all deliveries. The overall frequency of vaginal assisted deliveries increased from 1.65% to 2.87%. The frequency of caesarean section increased from 16% to 24.5%. CONCLUSION: A fundamental change in the trends of vaginal assisted deliveries occurred in the Moravian-Silesian region between 2002 to 2011. There was a significant reduction in the use of forceps and the rise in the use of vacuum extraction with an overall increase in vaginal assisted deliveries. In comparison with the results of the rest of the Czech Republic, the trends in the Moravian-Silesian region are more pronounced. During the analysed period a significant rise of the cesarean section deliveries occurred.
- MeSH
- extrakce porodnická metody trendy MeSH
- lidé MeSH
- porodnické kleště statistika a číselné údaje MeSH
- těhotenství MeSH
- vakuová extrakce porodnická trendy MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
The traumatic intracranial haemorrhage still remains a serious complication of instrumental deliveries with an uncertain prognosis. Regarding tentorial haemorrhage, surprisingly few clinical neurological data are available. Most of the references in literature are older case reports, associated frequently with an unfavourable outcome. We report a newborn after a serious tentorial haemorrhage with an excellent neurodevelopmental outcome. Computed tomography (CT) scan of our patient demonstrated an extensive bilateral tentorial haemorrhage extending to the foramen magnum. The newborn showed a good respiratory effort, but a neurological impairment including anisocoria, apathy, hypotonia, incomplete grasp and Moro reflex. Despite these signs, the development at 9 and 18 months of age was appropriate. The aim of this report is to accentuate that the prognosis of infants with tentorial haemorrhage should be always evaluated carefully with main respect to clinical signs. The outcome of the newborn even after a large tentorial haemorrhage can be surprisingly without a serious neurological deficit. Spontaneous breathing without support, normal blood pressure and absence of seizures are clinical indicators that may be associated with a good outcome despite an extensive tentorial haemorrhage.
- MeSH
- cerebrální krvácení diagnóza etiologie MeSH
- lidé MeSH
- novorozenec MeSH
- porodní poranění novorozence komplikace diagnóza MeSH
- porodnické kleště škodlivé účinky MeSH
- prognóza MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- dějiny 17. století MeSH
- porodnické kleště dějiny MeSH
- porodnictví dějiny MeSH
- Check Tag
- dějiny 17. století MeSH
- Publikační typ
- biografie MeSH
- časopisecké články MeSH
- historické články MeSH
- portréty MeSH
- Geografické názvy
- Skotsko MeSH
- O autorovi
- Smellie, William
The use of forceps delivery has been at the height of obstetric methods for centuries. They have even been described as "royal", since from the time of their discovery they have helped solve even the most difficult delivery problems. In the past couple of decades, however, the use of alternative delivery tools, especially the vacuum extractor, have become more widespread during vaginal deliveries. The aim of this paper is to evaluate the current status of the use of forceps delivery and compare them with vacuum extraction, another tractive method. Published data, particularly from the Cochran database, are supplemented by personal experience.
OBJECTIVE: To determine the incidence and range of anal dilation during the final phase of the second stage of labor and shortly after delivery; determine whether parity affects anal dilation; and obtain anthropometric data for future projects. METHODS: The anal diameter was measured on admission, when the fetal head crowned, and after suturing perineal injury in 142 women delivered between August 2008 and May 2009 at University Hospital Pilsen and District Hospital Klatovy, in the Czech Republic. RESULTS: The anus was dilated during the second stage of labor in all women, and differences between primiparas and multiparas were not significant. The medians for both the anteroposterior and transverse diameters were 25 mm. No measured variable was statistically associated with anal sphincter dilation. CONCLUSION: Anal dilation during the second stage of labor causes anthropometric changes to the perineum. This ought to be considered when designing anthropometric studies and in studies aiming at minimizing anal sphincter trauma during delivery.
- MeSH
- anální kanál zranění patologie MeSH
- dilatace patologická patologie MeSH
- dospělí MeSH
- druhá doba porodní * MeSH
- incidence MeSH
- kohortové studie MeSH
- komplikace porodu epidemiologie patologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- perineum zranění MeSH
- porodnické kleště škodlivé účinky MeSH
- těhotenství MeSH
- vedení porodu škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: The aim of this study was to identify trends in operative vaginal delivery rates and caesarean sections at Faculty Hospital in Olomouc and comparing with mean results of the Czech Republic. DESIGN: Retrospective epidemiological study. SETTING: Gynaecology and Obstetrics Clinic Medical Faculty Palacky University and Faculty Hospital in Olomouc. METHODS: Analysis of data drawn from obstetric medical records from 1. 1. 1993 to 31. 12. 2008--rating the frequency, evolutionary trends and associated risk factors. RESULTS: In this time period 26,679 children born, by caesarean section 5,916 (22.2%), ventouse 759 (2.8%) and forceps 526 (2.0%). The frequency of vaginal operations is higher than the average of the Czech Republic and from second half 90s of the 20th century no more increased. For caesarean section, however, is an upward trend (P for trend = 0.035, Cox-Stuart test). The increasing proportion of complex of 4 risk factors on the frequency of caesareans: 1 low birth weight below 2.5 kg (32.2%), 2 multiple pregnancy (18%), 3 caesareans in history (15.5%), 4 mothers over the age of 35 years (11.2%). Cumulative share of all four factors in the total number of abdominal delivery has reached a mean of 52.91% (95% CI 49.58-56.24), median = 53.75 (97.9% CI 48.64-57.32). CONCLUSION: Analysis of the development of operational termination of pregnancy confirms the significantly higher frequency of operational interventions in Olomouc compared to an average of the Czech Republic. Changes in risk profile of patients (often referred to the demographic factors) is not enough to explain the causes of the rising frequency of caesareans. The increase of invasive obstetrics undoubtedly contributes to changes in obstetric practice.
- MeSH
- císařský řez trendy MeSH
- lidé MeSH
- porodnické kleště statistika a číselné údaje MeSH
- těhotenství MeSH
- vakuová extrakce porodnická trendy MeSH
- vedení porodu trendy MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacký University, Olomouc. METHODS: The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. RESULTS: Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. CONCLUSIONS: From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn.
