Instrumental Rotation for Persistent Fetal Occiput Posterior Position: A Way to Decrease Maternal and Neonatal Injury?

Vidal, Fabien; Cristini, C.; Arnaud, Catherine; Parant, Olivier

doi:10.1371/journal.pone.0078124

Cited by 14 publications

(5 citation statements)

References 21 publications

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“…Instrumental rotations using forceps or Thierry spatulas (nonarticulating instruments, commonly used in France) may result in increased risks of birth injury for the fetus and higher degree perineal laceration in the mother. [16][17][18][19][20] Manual rotation of an occiput posterior position to an anterior position is a common and accepted practice in obstetrics. Success rates of the maneuver range from 70% to 90%, depending on the operator.…”

Section: Resultsmentioning

confidence: 99%

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Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions

Verhaeghe

Corroënne

Spiers

et al. 2021

Obstetrics &Amp; Gynecology

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions

Verhaeghe

Corroënne

Spiers

et al. 2021

Obstetrics &Amp; Gynecology

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“…The observed association between neuraxial analgesia and neonatal outcome could be mediated by a number of obstetric-related factors, including providers' skill and level of experience performing operative vaginal delivery, fetal position and station (the relation between the fetal presenting part and the ischial spines), type of forceps used (e.g., Simpson, Kjelland), suboptimal instrument placement, and method of instrumental delivery (i.e., direct traction forceps vs. rotational forceps). 16,[29][30][31] As an example, a rotational forceps delivery may not be tolerated in women experiencing obstructed labor without neuraxial analgesia, but these complex operative vaginal deliveries may be associated with worse neonatal outcomes compared to an uncomplicated vacuum delivery in a patient without neuraxial analgesia. A systematic review of perinatal morbidity after rotational forceps delivery lend support to this assertion.…”

Section: Discussionmentioning

confidence: 99%

Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery

et al. 2020

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Background Up to 84% of women who undergo operative vaginal delivery receive neuraxial analgesia. However, little is known about the association between neuraxial analgesia and neonatal morbidity in women who undergo operative vaginal delivery. The authors hypothesized that neuraxial analgesia is associated with a reduced risk of neonatal morbidity among women undergoing operative vaginal delivery. Methods Using United States birth certificate data, the study identified women with singleton pregnancies who underwent operative vaginal (forceps- or vacuum-assisted delivery) in 2017. The authors examined the relationships between neuraxial labor analgesia and neonatal morbidity, the latter defined by any of the following: 5-min Apgar score less than 7, immediate assisted ventilation, assisted ventilation greater than 6 h, neonatal intensive care unit admission, neonatal transfer to a different facility within 24 h of delivery, and neonatal seizure or serious neurologic dysfunction. The authors accounted for sociodemographic and obstetric factors as potential confounders in their analysis. Results The study cohort comprised 106,845 women who underwent operative vaginal delivery, of whom 92,518 (86.6%) received neuraxial analgesia. The proportion of neonates with morbidity was higher in the neuraxial analgesia group than the nonneuraxial group (10,409 of 92,518 [11.3%] vs. 1,271 of 14,327 [8.9%], respectively; P < 0.001). The unadjusted relative risk was 1.27 (95% CI, 1.20 to 1.34; P < 0.001); after accounting for confounders using a multivariable model, the adjusted relative risk was 1.19 (95% CI, 1.12 to 1.26; P < 0.001). In a post hoc analysis, after excluding neonatal intensive care unit admission and neonatal transfer from the composite outcome, the effect of neuraxial analgesia on neonatal morbidity was not statistically significant (adjusted relative risk, 1.07; 95% CI, 1.00 to 1.16; P = 0.054). Conclusions In this population-based cross-sectional study, a neonatal benefit of neuraxial analgesia for operative vaginal delivery was not observed. Confounding by indication may explain the observed association between neuraxial analgesia and neonatal morbidity, however this dataset was not designed to evaluate such considerations. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…The reported rate of vaginal operative delivery (VOD) ranges between 12 % and 15 % of all deliveries [1][2][3]. Since maternal as well as infantile outcomes depend on rapid termination of the delivery [4], assisted vaginal delivery is used to accelerate the second stage of labor [5].…”

Section: Introductionmentioning

confidence: 99%

“…Since maternal as well as infantile outcomes depend on rapid termination of the delivery [4], assisted vaginal delivery is used to accelerate the second stage of labor [5]. In these circumstances, vacuum extraction or delivery by forceps is useful and safe [1], if applied correctly. It results in a successful delivery in 90 % of cases [6].…”

Section: Introductionmentioning

confidence: 99%

Is There a Role for Cerebral Ultrasonography in Near-Term/Term Neonates Following Assisted Vaginal Delivery? A Prospective, Single-Center Study

et al. 2020

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Aim To evaluate the role of cerebral ultrasonography studies (CUSS) in detecting intracerebral and cranial pathologies (hemorrhages, ischemia, skull fractures) in near-term and term neonates following assisted vaginal delivery. Patients and Methods Prospective single-center study (11/2017–11/2018) at the University Children’s Hospital of Saarland, Homburg, Germany including newborns with a gestational age ≥ 36 weeks born by assisted vaginal delivery. In all newborns, a standardized CUSS was performed within the first three days of life prior to discharge. Results 200 neonates (43.0 % female, 57.0 % male; gestational age 39.6 ± 1.3 weeks) were included in this study (birth weight 3345.6 ± 450.6 g, body length 51.7 ± 2.5 cm, head circumference 35.0 ± 1.5 cm). 67 (33.5 %) neonates had minor external injuries of the scalp. 5 children showed clinical neurologic abnormalities: 4 (2.0 %) seizures and 1 facial palsy (0.5 %). In 34 (17.0 %) patients, minor incidental intracranial abnormalities unrelated to mode of delivery were detected on CUSS. No intracerebral, cranial pathologies or skull fractures were seen on routine CUSS. Conclusion Routine CUSS in newborns after assisted vaginal delivery did not yield clinically relevant results in our cohort. Clinical observation and selective CUSS in symptomatic newborns might be more efficient than routine CUSS.

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Instrumental Rotation for Persistent Fetal Occiput Posterior Position: A Way to Decrease Maternal and Neonatal Injury?

Cited by 14 publications

References 21 publications

Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions

Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions

Association between Neuraxial Labor Analgesia and Neonatal Morbidity after Operative Vaginal Delivery

Is There a Role for Cerebral Ultrasonography in Near-Term/Term Neonates Following Assisted Vaginal Delivery? A Prospective, Single-Center Study

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