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Assisted Delivery (assisted + delivery)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Commercial Hospital Discharge Packs for Breastfeeding Women

BIRTH, Issue 1 2001
J. K. Gupta
A substantive amendment to this systematic review was last made on 23 March 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down has advantages for women delivering their babies. Objectives: The objective of this review was to assess the benefits and risks of the use of different positions during the second stage of labour (i.e., from full dilatation of the cervix). Search strategy: Relevant trials are identified from the register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and from the Cochrane Controlled Trials Register. Selection criteria: Trials were included which compared various positions assumed by pregnant women during the second stage of labour. Randomised and quasi-randomised trials with appropriate follow-up were included. Data collection and analysis: Trials were independently assessed for inclusion, and data extracted by the two authors. Disagreements would have been resolved by consensus with an editor. Meta-analysis of data is performed using the RevMan software. Main results: Results should be interpreted with caution as the methodological quality of the 18 trials was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: 1Reduced duration of second stage of labour (12 trials,mean 5.4 minutes, 95% confidence interval (CI) 3.9,6.9 minutes). This was largely due to a considerable reduction in women allocated to use of the birth cushion. 2A small reduction in assisted deliveries (17 trials,odds ratio (OR) 0.82, 95% CI 0.69,0.98). 3A reduction in episiotomies (11 trials,OR 0.73, 95% CI 0.64,0.84). 4A smaller increase in second degree perineal tears (10 trials,OR 1.30, 95% CI 1.09,1.54). 5Increased estimated risk of blood loss > 500ml (10 trials,OR 1.76, 95% CI 1.34,3.32). 6Reduced reporting of severe pain during second stage of labour (1 trial,OR 0.59, 95% CI 0.41,0.83). 7Fewer abnormal fetal heart rate patterns (1 trial,OR 0.31, 95% CI 0.11,0.91). Reviewers' conclusions: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500 mL. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies. Citation: Gupta JK, Nikodem VC. Women's position during second stage of labour (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software. [source]

A randomised controlled trial of two instruments for vacuum-assisted delivery (Vacca Re-Usable OmniCup and the Bird anterior and posterior cups) to compare failure rates, safety and use effectiveness

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010
Glen D.L. MOLA
Background:, Most previous trials of vacuum-assisted delivery have been in settings with high rates of instrumental vaginal delivery (8,12%) and high rates of failure to deliver with the intended instrument (20,30%). Over the past 20 years, vacuum-assisted delivery rates at the Port Moresby General Hospital have been 3,4% with failure rates of <3%. Objective:, The objective is to compare the failure rates of two vacuum extractor instruments, the Vacca Re-Usable Omnicup and the Bird Vacuum delivery system (anterior and posterior cups). Setting:, Port Moresby General national referral and teaching Hospital (PMGH), Papua New Guinea. Population:, Two hundred consecutive women requiring assisted delivery, June,December, 2007. Methods:, When a woman required an assisted delivery, she was randomised into either the Vacca Re-Usable Omnicup (Clinical Innovations Inc.) or Bird anterior or posterior metal cup (depending upon the position of the vertex). One hundred women were randomised to each vacuum device. Statistical analysis was on ,an intention-to-treat' basis. Main outcome measures:, The main outcome measure was the successful completion of the delivery with the allocated instrument. Secondary outcomes were maternal trauma (episiotomy and trauma to the maternal genital tract), significant scalp trauma (sub-galeal haemorrhage or serious abrasion) and fetal and neonatal outcomes (Apgar score less than seven at 5 minutes, days spent in the Special Care Nursery and neonatal death). Results:, Failure rates for both Omnicup (2/100) and Bird metal cups (6/100) were not statistically different (RR 1.05, 95% CI 0.99,1.12; P = 0.17). Rates of maternal trauma and fetal scalp trauma were similar in both groups. Conclusion:, Both the Vacca re-useable Omnicup and the Bird metal cups are very effective instruments to achieve successful assisted delivery and equally so. Failures and problems were associated with not applying the vacuum cup to the flexion point on the fetal scalp and the mechanical faults with vacuum equipment devices. [source]

Maternal thyroid hormone concentration during late gestation is associated with foetal position at birth

CLINICAL ENDOCRINOLOGY, Issue 5 2009
Hennie A. Wijnen
Summary Objective, To evaluate whether there is an association between maternal thyroid hormone and foetal cephalic head position at term gestation. Context, Rotation and flexion of the head enables the foetus to negotiate the birth canal. Low-normal range thyroid hormone concentrations in euthyroid pregnant women constitute a risk of infant motor abnormality. We hypothesized that low normal maternal thyroid hormone levels are associated with increased risk of abnormal foetal position at delivery. Design, In 960 healthy Dutch women with term gestation and cephalic foetal presentation, thyroid parameters [foetal T4 (FT4), TSH and thyroid peroxidase antibody] were assessed at 36 weeks of gestation, and related to foetal head position (anterior cephalic vs. abnormal cephalic) and delivery mode (spontaneous vs. assisted delivery). Results, Women presenting in anterior position (n = 891) had significantly higher FT4 levels at 36 weeks of gestation than those with abnormal cephalic presentation (n = 69). There were no between-group differences for TSH. Regression analyses indicated that the risk of abnormal head position decreased as a function of increasing FT4 [single odds ratio (OR) = 0·87, 95% confidence intervals (CI) 0·77,0·98; multivariate OR = 0·88, 95% CI 0·72,0·99)]. A similar inverse relationship between maternal FT4 and risk of assisted delivery was obtained (OR = 0·86, 95% CI 0·79,0·95; OR = 0·91, 95% CI 0·84,0·98). Conclusion, The lower the maternal FT4 concentration at 36 weeks of gestation, the higher the risk of abnormal cephalic foetal presentation and assisted delivery. [source]