Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin ...Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n = 128 745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8% , in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal- operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal- lacerations were less frequent in primipara if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is < 36 cm, and if no further traumas of the birth canal occur. Results were similar for multiparae: severe perineal lacerations were less frequent if the active period of labour is < 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well- justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.展开更多
Objective: To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. Methods: In 55 subjects with fecal incontinence, 42 subjects with obstructed defecatio...Objective: To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. Methods: In 55 subjects with fecal incontinence, 42 subjects with obstructed defecation, and 45 healthy subjects without defecatory symptoms, a urogynecologist assessed pelvic organ prolapse by the pelvic organ prolapse quantification system, and a gastroenterologist evaluated perineal descent during simulated evacuation. A multiple logistic regression model evaluated whether obstetric-gynecological variables, including pelvic organ prolapse, could discriminate among controls, subjects with fecal incontinence, and subjects with obstructed defecation. Results: Fifty-five percent of controls, 42% of those with obstructed defecation, and 29% of those with fecal incontinence had stage Ⅱ or greater prolapse by clinical examination. Eleven percent of controls, 7% of those with obstructed defecation, and 47% of subjects with fecal incontinence had a forceps delivery. Eighteen percent of controls, 31% of those with obstructed defecation, and 64% of those with fecal incontinence had a hysterectomy. Even after controlling for a higher prevalence of obstetric risk factors and hysterectomy, fecal incontinence was associated with a lower risk of stage Ⅱ or greater pelvic organ prolapse (odds ratio for fecal incontinence in ≥ stage Ⅱ pelvic organ prolapse relative to stage 0 pelvic organ prolapse = 0.1, 95% confidence interval 0.01-0.53). In contrast, pelvic organ prolapse severity was not associated with control versus obstructed defecation status. Seven percent of controls, 18% of subjects with obstructed defecation, and 7% of those with fecal incontinence had increased perineal descent during simulated evacuation. Excessive perineal descent was associated (P <.01) with pelvic organ prolapse. Conclusion: Despite a higher prevalence of risk factors for pelvic floor injury, pelvic organ prolapse severity was lower in those with fecal incontinence than in subjects without bowel symptoms. How展开更多
OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliverie...OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliveries that occurred from January 1, 1998, to August 30, 1999, at Winthrop-University Hospital. Maternal demographics and delivery characteristics were recorded. Maternal outcomes, such as use of episiotomy and presence of lacerations, were studied. Neonatal outcomes evaluated were Apgar scores, neonatal intensive care unit admissions, cephalohematomas, instrument marks and bruising, and caput and molding. RESULTS: Of 508 operative vaginal deliveries, 200 were forceps and 308 were vacuum assisted. Forceps were used more often than vacuum for prolonged second stage of labor (P = .001). There was a higher rate of epidural (P = .02) and pudendal(P < .001) anesthesia, episiotomies (P = .01), maternal third-and fourth-degree perineal (P < .001) and vaginal lacerations (P = .004) with the use of forceps, whereas periurethral lacerations were more common in vacuum-assisted (P = .026) deliveries. More instrument marks and bruising (P < .001) were found in the neonates delivered by forceps, whereas there was a greater incidence of cephalohematomas (P = .03) and caput and molding (P < .001) in the neonates delivered with vacuum. Multivariable logistic regression analysis showed that forceps use was associated with an increase in major perineal and vaginal tears (odds ratio [OR] 1.85; 95%confidence interval [CI] 1.27, 2.69; P = .001), an increase in instrument marks and bruising (OR 4.63; 95%CI 2.90, 7.41; P < .001) and a decrease in cephalohematomas (OR 0.49; 95%CI 0.29, 0.83; P = .007) compared with the vacuum. CONCLUSIONS: Maternal injuries are more common with the use of forceps. Neonates delivered with forceps have more facial injuries, whereas neonates delivered with vacuum have more cephalohematomas.展开更多
Objective: To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries. Design: Population based study. Setting: US linked natality and mortality birth cohort file and th...Objective: To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries. Design: Population based study. Setting: US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file. Participants: Singleton livebirths in the United States (n = 11 639 388) and New Jersey (n = 375 351). Main outcome measures: Neonatal morbidity and mortality. Results: Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95%confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; ≥30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery.Sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears. Conclusion: Although vacuum extraction does have risks,it remains a safe alternative to forceps delivery.展开更多
文摘Purpose: Is an episiotomy a protective or a risk factor for severe perineal lacerations; which other obstetric influencing factors exist? Patients and Methods: Retrospective analysis of the perinatal data from Berlin from 1993 to 1999. Study inclusion criteria: vaginal delivery in singleton pregnancies. Setting up of two study subgroups: vaginal delivery of singletons, cephalic presentation >34/0 gestational weeks, birth weight 2500 to 4000 g. Separate analysis of the primi- (subgroup 1) and multiparae (subgroup 2). Multivariate analysis with stepwise logistic regression. Identification of factors which correlate with severe perineal lacerations. Results: 74.7% of all vaginal deliveries of singletons (n = 128 745) fulfilled the inclusion criteria. In spontaneous deliveries, the frequency of episiotomy was 60.8% , in vacuum extraction and forceps delivery 95.3 and 98.6% respectively. Severe perineal lacerations were significantly more frequent in vaginal- operative deliveries than in spontaneous vaginal delivery. If no episiotomy was incised, perineal lacerations stage 3/4 were less frequent in spontaneous and vacuum extraction deliveries. Following regression analysis, severe perineal- lacerations were less frequent in primipara if the active period of labour is ≤ 10 minutes, if no episiotomy is incised, in vacuum than in forceps extraction, if fetal head circumference is < 36 cm, and if no further traumas of the birth canal occur. Results were similar for multiparae: severe perineal lacerations were less frequent if the active period of labour is < 10 minutes, if no episiotomy is incised, and if no vaginal operative delivery occurs. Conclusions: Episiotomies seem to carry one of the highest risks for a severe perineal laceration among the avoidable risk factors. Therefore, use of an episiotomy must be restricted to well- justified cases. When considering perineal protection, vacuum extraction should be preferred to forceps extraction.
文摘Objective: To compare the prevalence of pelvic organ prolapse in subjects with defecatory disorders with that in control subjects. Methods: In 55 subjects with fecal incontinence, 42 subjects with obstructed defecation, and 45 healthy subjects without defecatory symptoms, a urogynecologist assessed pelvic organ prolapse by the pelvic organ prolapse quantification system, and a gastroenterologist evaluated perineal descent during simulated evacuation. A multiple logistic regression model evaluated whether obstetric-gynecological variables, including pelvic organ prolapse, could discriminate among controls, subjects with fecal incontinence, and subjects with obstructed defecation. Results: Fifty-five percent of controls, 42% of those with obstructed defecation, and 29% of those with fecal incontinence had stage Ⅱ or greater prolapse by clinical examination. Eleven percent of controls, 7% of those with obstructed defecation, and 47% of subjects with fecal incontinence had a forceps delivery. Eighteen percent of controls, 31% of those with obstructed defecation, and 64% of those with fecal incontinence had a hysterectomy. Even after controlling for a higher prevalence of obstetric risk factors and hysterectomy, fecal incontinence was associated with a lower risk of stage Ⅱ or greater pelvic organ prolapse (odds ratio for fecal incontinence in ≥ stage Ⅱ pelvic organ prolapse relative to stage 0 pelvic organ prolapse = 0.1, 95% confidence interval 0.01-0.53). In contrast, pelvic organ prolapse severity was not associated with control versus obstructed defecation status. Seven percent of controls, 18% of subjects with obstructed defecation, and 7% of those with fecal incontinence had increased perineal descent during simulated evacuation. Excessive perineal descent was associated (P <.01) with pelvic organ prolapse. Conclusion: Despite a higher prevalence of risk factors for pelvic floor injury, pelvic organ prolapse severity was lower in those with fecal incontinence than in subjects without bowel symptoms. How
文摘OBJECTIVE: To estimate the differences in immediate maternal and neonatal effects of forceps and vacuum-assisted deliveries. METHODS: We conducted a medical record review of all forceps and vacuum-assisted deliveries that occurred from January 1, 1998, to August 30, 1999, at Winthrop-University Hospital. Maternal demographics and delivery characteristics were recorded. Maternal outcomes, such as use of episiotomy and presence of lacerations, were studied. Neonatal outcomes evaluated were Apgar scores, neonatal intensive care unit admissions, cephalohematomas, instrument marks and bruising, and caput and molding. RESULTS: Of 508 operative vaginal deliveries, 200 were forceps and 308 were vacuum assisted. Forceps were used more often than vacuum for prolonged second stage of labor (P = .001). There was a higher rate of epidural (P = .02) and pudendal(P < .001) anesthesia, episiotomies (P = .01), maternal third-and fourth-degree perineal (P < .001) and vaginal lacerations (P = .004) with the use of forceps, whereas periurethral lacerations were more common in vacuum-assisted (P = .026) deliveries. More instrument marks and bruising (P < .001) were found in the neonates delivered by forceps, whereas there was a greater incidence of cephalohematomas (P = .03) and caput and molding (P < .001) in the neonates delivered with vacuum. Multivariable logistic regression analysis showed that forceps use was associated with an increase in major perineal and vaginal tears (odds ratio [OR] 1.85; 95%confidence interval [CI] 1.27, 2.69; P = .001), an increase in instrument marks and bruising (OR 4.63; 95%CI 2.90, 7.41; P < .001) and a decrease in cephalohematomas (OR 0.49; 95%CI 0.29, 0.83; P = .007) compared with the vacuum. CONCLUSIONS: Maternal injuries are more common with the use of forceps. Neonates delivered with forceps have more facial injuries, whereas neonates delivered with vacuum have more cephalohematomas.
文摘Objective: To compare the risk of neonatal and infant adverse outcomes between vacuum and forceps assisted deliveries. Design: Population based study. Setting: US linked natality and mortality birth cohort file and the New Jersey linked natality, mortality, and hospital discharge summary birth cohort file. Participants: Singleton livebirths in the United States (n = 11 639 388) and New Jersey (n = 375 351). Main outcome measures: Neonatal morbidity and mortality. Results: Neonatal mortality was comparable between vacuum and forceps deliveries in US births (odds ratio 0.94, 95%confidence interval 0.79 to 1.12). Vacuum delivery was associated with a lower risk of birth injuries (0.69, 0.66 to 0.72), neonatal seizures (0.78, 0.68 to 0.90), and assisted ventilation (< 30 minutes 0.94, 0.92 to 0.97; ≥30 minutes 0.92, 0.88 to 0.98). Among births in New Jersey, vacuum extraction was more likely than forceps to be complicated by postpartum haemorrhage (1.22, 1.07 to 1.39) and shoulder dystocia (2.00, 1.62 to 2.48). The risks of intracranial haemorrhage, difficulty with feeding, and retinal haemorrhage were comparable between both modes of delivery.Sequential use of vacuum and forceps was associated with an increased risk of need for mechanical ventilation in the infant and third and fourth degree perineal tears. Conclusion: Although vacuum extraction does have risks,it remains a safe alternative to forceps delivery.
