Effect of Mode of Delivery in Nulliparous Women on Neonatal Intracranial Injury

Towner, Dena; Castro, Mary Ames; Eby-Wilkens, Elaine; Gilbert, William M.

doi:10.1097/00006254-200005000-00008

Cited by 98 publications

(157 citation statements)

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“…The association of intracranial bleeds with assisted delivery has been described previously. Towner et al 6 observed a relative risk for all intracranial haemorrhage types (subdural, cerebral, subarachnoid and intraventricular) of 2.9 for forceps delivery, which increased to 7.4 for deliveries by forceps after failed vacuum extraction (absolute risk 1 in 256).…”

Section: Discussionmentioning

confidence: 99%

Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

2010

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A term infant developed stridor, hoarse cry and respiratory distress after forceps-assisted delivery. Oral feeding resulted in aspiration. Flexible laryngoscopy showed a right-sided vocal cord paralysis (VCP). A magnetic resonance image (MRI) of the brain revealed an ovoid lesion in the posterior fossa impinging on the brainstem, which was considered to represent a subdural haematoma. Clinical signs of vocal cord palsy and the associated MRI changes resolved spontaneously by 6 weeks of age. Vocal cord palsy is a common cause of stridor in newborn infants, although in many cases it is considered idiopathic. This is the first report of vocal cord palsy associated with subdural haemorrhage after instrumental delivery, and may represent an important and previously unappreciated cause of VCP. This case highlights the importance of magnetic resonance brain imaging in those infants with VCP in whom the aetiology is uncertain.

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Section: Discussionmentioning

confidence: 99%

Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

2010

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“…Several reports link birth trauma (intracranial haemorrhage) with the use of vacuum, forceps and even caesarean section, perhaps explaining why up to 84% of American institutions continue to use fundal pressure despite a veritable absence of objective study 7,16 .…”

Section: Discussionmentioning

confidence: 99%

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour

Buhimschi¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To investigate the relationship between intrauterine pressure and the application of a standardised fundal pressure manoeuvre, and to determine the maternal, fetal and labour characteristics that modulate the relationship. Design Prospective measurement of intrauterine pressure during the second stage of labour.Setting North American university hospital.Population Forty full-term women in spontaneous labour were studied during the second stage. Each woman acted as her own control. All women laboured with requested epidural analgesia. Methods A fundal pressure manoeuvre was performed so as to standardise the level of force and the surface area of application. Intrauterine pressure was measured using a sensor-tip catheter. Five interventions were analysed: 1. valsalva during a uterine contraction; 2. fundal pressure and valsalva during a contraction; 3. fundal pressure during a contraction without valsalva; 4. fundal pressure in the absence of uterine contractions; and 5. valsalva in the absence of uterine contractions. Results Women in the second stage of labour transiently increased their expulsive force (as reflected by intrauterine pressure) by 86% of their baseline contraction using valsalva and fundal pressure simultaneously. The efficiency by which both contraction-enhancing manoeuvres increased intrauterine pressure was directly related to gestational age and inversely related to myometrial thickness. Conclusion Fundal pressure applied under controlled conditions significantly increases intrauterine pressure in some, but not all women. Simultaneous measurement of intrauterine pressure, to maintain feedback during application will create a 'controlled environment' for the obstetrician and reassurance that this manoeuvre can be applied in a controlled fashion. Future delineation of the group of women that could benefit from fundal pressure, as well as the group that is refractory is essential to avoid unnecessary or delayed operative interventions.

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“…3 Operative vaginal deliveries comprise approximately 9 to 12% of all deliveries, with decreasing frequency in recent reports. [4][5][6] Importantly, operative vaginal delivery, using a single instrument, affords no increased risk of major neonatal injury compared with cesarean. For instance, in a study of nearly 600 000 births in California, intracranial hemorrhage was not increased in neonates delivered by forceps or vacuum compared with those delivered by cesarean.…”

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confidence: 99%

“…For instance, in a study of nearly 600 000 births in California, intracranial hemorrhage was not increased in neonates delivered by forceps or vacuum compared with those delivered by cesarean. 6 Operative vaginal delivery, however, is not without risk of maternal morbidity. Risk of third or fourth degree perineal laceration is increased with operative vaginal delivery.…”

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confidence: 99%

“…Likely owing to this last factor, the proportion of operative vaginal deliveries which are forceps has fallen over the past decade. [4][5][6] In this issue of the Journal of Perinatology, Dr Powell et al 17 report that only about half of graduating fourth year residents responding to a survey felt competent in forceps-assisted deliveries. Interestingly, the vast majority of respondents wished to be further trained to perform forceps deliveries.…”

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confidence: 99%

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Forceps delivery: potential benefits and a call for continued training

Shaffer

Caughey

2007

J Perinatol

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Obstetricians, charged with providing optimal care for women and their babies, are at a crossroads. The cesarean delivery rate continues to increase in the United States, with 30.2% of all births in 2005 via cesarean. 1 In addition, the primary cesarean rate, 20.6% of all deliveries in 2004, continues to climb, continuing the trend of annual 5% increases. 2 More than 20% of cesarean deliveries for dystocia are performed during the second stage of labor. 3 Operative vaginal deliveries comprise approximately 9 to 12% of all deliveries, with decreasing frequency in recent reports. [4][5][6] Importantly, operative vaginal delivery, using a single instrument, affords no increased risk of major neonatal injury compared with cesarean. For instance, in a study of nearly 600 000 births in California, intracranial hemorrhage was not increased in neonates delivered by forceps or vacuum compared with those delivered by cesarean. 6 Operative vaginal delivery, however, is not without risk of maternal morbidity. Risk of third or fourth degree perineal laceration is increased with operative vaginal delivery. 7 Less clear are the risks of urinary and fecal incontinence in those undergoing operative vaginal delivery compared with cesarean during the second stage of labor. Although vaginal delivery appears to increase the risk of incontinence in the short-term postpartum period, it is not clear whether the increased risk persists throughout a woman's lifetime. [8][9][10][11] Thus, increased risk of maternal soft tissue injury and an unclear risk of incontinence must be weighed against the known risks of cesarean. Compared with vaginal birth, cesarean has been linked to longer hospitalization, increased risks of thromboembolism and infection, and higher rates of postpartum maternal death. 12 In addition, women with a primary cesarean who plan on future children are more than 90% likely to deliver via repeat cesarean with its concomitant risks. 2 Further, in these subsequent pregnancies, there are increased risks of placenta previa and unexplained intrauterine fetal death (IUFD). 13,14 Thus, without neonatal benefit and the potential for increased morbidity from repeat cesarean delivery, operative vaginal delivery may confer the least maternal and neonatal risk.The choice of instrument for operative vaginal delivery is determined by several factors, including concern for maternal and neonatal morbidity, chance of success and operator expertise.Vacuum-assisted deliveries are associated with increased rates of neonatal cephalohematoma and retinal hemorrhage. 7 Further, it has been noted that the rate of shoulder dystocia is higher with vacuum-assisted deliveries. 15,16 In addition, the chance of a failed operative delivery using vacuum is almost two times greater than with forceps. 7 Despite all of these considerations, it may be the last one, operator expertise, which ultimately determines the instrument of choice for many clinicians. Likely owing to this last factor, the proportion of operative vaginal deliveries which are forceps h...

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Effect of Mode of Delivery in Nulliparous Women on Neonatal Intracranial Injury

Cited by 98 publications

References 0 publications

Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

The effect of fundal pressure manoeuvre on intrauterine pressure in the second stage of labour

Forceps delivery: potential benefits and a call for continued training

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