Blood type association with bleeding outcomes at delivery in a large multi-center study.

Postpartum hemorrhage is a leading cause of maternal death globally. Recent studies have associated Type-O group to increased risk of bleeding. We aimed to determine if women with Type-O blood are at higher risk of PPH. This is a retrospective cohort analysis of a multi-center database included women admitted to labor and delivery from January 2015 to June 2018. All deliveries resulting in live birth were included. Association between Type-O and non Type-O were examined using chi-square test and fishers exact test. Prevalence of postpartum hemorrhage, estimated blood loss, drop in hematocrit and red blood cell transfusion were compared. The matched sample included 40,964 Type-O and the same number of no Type-O. The overall prevalence of postpartum hemorrhage was 6.4%, and there was no difference in the prevalence of PPH among Type-O compared to non Type-O (6.38% vs. 6.37% respectively; p = 0.96). There was no difference in hematocrit drop and estimated blood loss between Type-O and non Type-O in all deliveries. However, in cesarean delivery there was a significant difference in blood loss among the two groups. Finally, Type-O had 1.09-fold increased risk for transfusion compared to non Type O (95% CI 0.9-1.34). There is an association between Type-O group and risk of bleeding in women undergoing cesarean delivery. More prospective studies, taking into account coagulation profile, platelet count and tissue factors, are needed to draw a conclusion on whether ABO system can be considered a heritable risk of postpartum hemorrhage.

[Czech Hospital in Uganda and quality of obstetric care]. / Ceská nemocnice v Ugande a kvalita porodnické péce.

OBJECTIVE: The target was to evaluate the present state of obstetric care in Czech Hospital in Buikwe in Uganda. We evaluated a professional level of hospital physicians, their obstetric expertise and technical equipment of delivery theatre and mobile surgery and we provided a short 4 months evaluation of deliveries in main view of obstetric pathologies, frequency of caesarean sections and maternal mortality. METHODS AND RESULTS: In period from October 2014 to January 2015 there was evaluated a group of 374 women, admited to labour at delivery theatre. We evaluated parity of women, number and indications of caesarean sections, age of women and obstetric finding by admission. The most of our patients were primiparas and secundiparas, the caesarean section was performed in 23,8% of cases and the most frequent indication of it was threatened rupture of the uterus, state after caesarean section, cephalopelvic disproportion and obstructed labour. Two women died. By evaluation of quality of obstetric care we have found some serious lacks. Ugandan doctors are not obstetricians, they have no experience with vaginal obstetric operations, the Hospital has no fetal-monitor and no possibility for a transport of emergency cases. CONCLUSIONS: The Hospital needs expert help from Czech Republic, as doctors-obstetricians so as some equipment for delivery theatre and above all suitable car for urgent transport and for use of mobile surgery.

Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity.

To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Ala Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction (caput, jaundice, cephalohaematoma). Serous neonatal morbidity was rare for both groups.

[Indications and prognosis of forceps delivery at the University Hospital Center of Dakar]. / Indications et pronostic de l'accouchement par forceps au CHU de Dakar.

Based on a study of 382 cases registered in a five years periods (1992-1996), the prevalence of forceps delivery is evaluated at 16 per 1000 deliveries. Averagely these are young (24.5 years), primipare (63%) at term and having problems of abnormal labour. The mains indications are: assistance of expulsion (47.1%), severe foetal distress (15.6%), scarred uterus (15.2%) and eclampsia (8.9%). The most frequent applications are the occipito-pubic grasp (51.3%) and left anterior occipito-iliac grasp (34.8). The maternal morbidity prognosis (6%) is represented by cervical or vaginal traumas and infections. The neonatal prognosis is marked by neonatal mortality rate of 50 per 1000 of life deliveries and by a morbidity rate of 3.4% essentially represented by cutaneous lesions.

Neonatal outcome of breech babies in Toa Payoh Hospital 1984-1989.

From 1984 to 1989, a total of 575 breech babies were born out of 21,243 livebirths (2.71%) in the Toa Payoh Hospital, Singapore. There were 259 male and 316 female infants, a sex ratio of 1 to 1.22. There were also no marked differences in the frequency of breech birth among the different racial groups. Many breech babies (385 or 67%) were delivered by Caesarean section and the mortality and morbidity were noted to be low in this series. We had 7 deaths, all weighing below 2000gm and only one, a premature infant, was delivered by Caesarean section. The majority of the infants had no evidence of asphyxia at birth (87.7%); and for those who had asphyxia (13.3%), two-thirds were delivered vaginally and one-third, by Caesarean section. The malformation rate in breech babies was twice that of non-breech babies (7.13% vs 3.08%, p = 10(-6)). Most birth defects were minor in nature. Only 10% of birth defects were major malformations. 5.9% (34) of all the breech babies were low birth weight (LBW), 1/3 (11) of them were delivered by Caesarean section with one death. However, there was no increasing trend of Caesarean section for LBW breech infants in the Hospital. Over the past 6 years, out of the 23 LBW breech babies delivered vaginally, 6 deaths were noted. There were 13 breech stillbirths, the majority of which were macerated (7/13 or 53.8%). The stillbirth rate (SBR) for breech was 22 per 1000 breech livebirths and stillbirths. The SBR for babies born normally was 5.15. The corrected breech SBR was 18.7 after exclusion of lethal malformations.(ABSTRACT TRUNCATED AT 250 WORDS)

[About the choice of extraction instrument for vaginal operative termination in vertex presentation (author's transl)]. / Uber die Wahl des Extraktionsinstrumentes zur vaginalen operativen Geburtsbeendigung bei Schädellagen

The common separation of indications at the First University Clinic for Obstetrics and Gynecology in Vienna concerning the choice of extraction instrument in cases of operative termination of vaginal delivery out of vertex position is being demonstrated. When there is only a slight increase of resistance in the delivery mechanism, when the child is mature, when there is no attitude of deflexion, and where there is no real reason for a speedy termination of delivery, the vacuum extractor comes into use. In cases of child emergency, of considerable increase of delivery mechanism resistance, of immaturity and attitude of deflexion, an extraction by means of obstetrical forceps is performed. Out of 547 deliveries terminated by means of extraction the sub- and postpartal mortality amounted to 2,19%. The number of prematures (7,5%) in this material did not differ from the total delivery material of the clinic. After forceps extraction 5 out of 419 children (2,8%) died. After vacuum extraction one child out of 105 (0,95%) died. In 23 cases where obstetrical forceps had to be used after vacuum extraction 2 children died (8,7%). The morbidity of the children was measured by means of the Apgar Score and of the injury frequency. Here the two extraction methods showed no significant differencies. The combined application of both extraction instruments however, showed an increase of morbidity. Injuries of the mother were almost exclusively found after forceps extraction.

[Some considerations on forceps delivery with excenter handle (author's transl)]. / Geburtsmechanische Uberlegungen zur Zangenextraktion mit Exzentergriff

The introduction of electronic monitoring techniques in delivery increasingly has lead to the use of vaginal surgery in delivery. Vacuum and forceps extraction, in our view, do not compete with each other. Years ago forceps extraction was decisively improved by introducing the axial traction forceps. However, we believe that this technique has not been given due attention and is not applied widely enough. In vacuum extraction and in forceps deliveries without axial traction considerable part of the force is exerted in the direction of the symphysis. When using the excentric handle forceps, it is necessary in addition to the traction and pressure components to include the lever action. This is a so-called couple of forces. The additional torque involved in the use of an axial traction forceps shifts the fetal head during extraction in the direction of the hollow of the sacrum. The force needed for this shift and the progression of the head is many times less than that required for conventional forceps extraction. This is due to the absence of the component directed at the symphysis which impedes delivery. The axial traction forceps may also be used in case of the infant's abnormal positioning of the head. In case of a transverse position of the fetal head, a special fastener on the forceps makes it possible to use an excentric handle on the traction hook of the Kielland forceps and thus render possible rotation of the fetal head from the transverse position. The extentric handle in forceps extraction is optimal in order to overcome increased mechanical resistance to delivery. Adjustment of the handles to all types of forceps being used today is possible. From the results mentioned it is clear that the use of the axial traction forceps constitutes a valuable contribution toward declining perinatal mortality rates.