Operative vaginal delivery: practice patterns and outcomes at a tertiary general hospital

INTRODUCTION@#There has been a global decrease in operative vaginal deliveries, with a marked shift towards the vacuum extractor. However, little is known about the trends in operative vaginal delivery in Singapore.@*METHODS@#A retrospective study was conducted on all operative vaginal deliveries performed from 2012 to 2017 at Singapore General Hospital (SGH). Maternal outcomes in terms of postpartum haemorrhage and obstetric anal sphincter injuries were compared between forceps- and vacuum-assisted deliveries. Neonatal outcomes in terms of neonatal intensive care unit (NICU) admission and clinically significant neonatal events were compared. The instrument preference of obstetricians was analysed.@*RESULTS@#A total of 906 consecutive operative vaginal deliveries were included in the study, comprising 461 forceps- and 445 vacuum-assisted deliveries. The rate of operative vaginal delivery was maintained at approximately 10% from 2012 to 2017. Neonatal cephalohematomas were more common after vacuum-assisted deliveries. Other maternal and neonatal outcomes did not differ significantly between the two groups. Clinically significant neonatal events were mostly due to shoulder dystocia, whereas all cases of NICU admissions were not directly related to the mode of delivery. Obstetricians' choice of instrument appeared to reflect personal preference and was not affected by the year of graduation.@*CONCLUSION@#The rates of neonatal and maternal morbidity were low at SGH. Overall instrument use of forceps and vacuum was balanced, and proficiency in both was demonstrated by all operators. Operative vaginal delivery remains an essential skill in facilitating safe vaginal delivery, which should be maintained to keep Caesarean section rates in check.

Can the cervical length in mid-trimester predict the use of vacuum in vaginal delivery?

Research progress of vacuum extraction and its combined technologies in volatile oil from traditional Chinese medicine / 中草药

With the expansion of the application field of traditional Chinese medicine volatile oil, the research on novel extraction technology and method is increasing. Vacuum hydrodistillation extraction, a new extraction process, reduces the boiling point of the solvent by adjusting the vacuum degree. Therefore, it can keep the solvent boiling at low temperature, so that the volatile oil components are not easily destroyed. This paper has reviewed the principle, advantages and disadvantages, application status of vacuum technology in the field of traditional Chinese medicine volatile oil and the application of vacuum combined technologies including instant controlled pressure drop, ultrasonic combined vacuum extraction, microwave combined vacuum extraction and supercritical CO2 combined vacuum extraction. Based on the practical application of these new technologies and processes in the field of traditional Chinese medicine volatile oil, the existing problems were analyzed and discussed, which will provides new ideas for the extraction process and equipment upgrade of traditional Chinese medicine volatile oil.

The clinical characteristics and prognosis of subgaleal hemorrhage in newborn / 소아과

PURPOSE: Subgaleal hemorrhage (SGH) is a rare but potentially fatal condition in newborns; however, few studies have reported on this condition. We aimed to identify the clinical characteristics and prognostic factors of SGH. METHODS: We retrospectively reviewed the medical records of 20 neonates diagnosed with SGH between January 2000 and June 2017. Enrolled neonates were clinically diagnosed when they had tender fluctuant scalp swelling that crossed the suture lines. RESULTS: Among 20 neonates with SGH, 12 were boys and 7 were girls; median hospitalization duration was 9.7±6.9 days. Fourteen neonates (70%) were born via vacuum-assisted vaginal delivery, and 4 via vacuum-assisted cesarean section. Of the neonates enrolled, half of them initially showed unstable vital signs, including apnea, desaturation, and cyanosis. Ten neonates had acidosis and 3 had asphyxia (pH < 7.0). Intracranial lesions associated with SGH were observed in 15 neonates (75%), including subdural hemorrhage (50%), subarachnoid hemorrhage (15%), intraventricular hemorrhage (5%), cerebral infarct (15%), skull fracture (30%), and cephalohematoma (20%). Twelve neonates (60%) required transfusion, 5 (25%) had seizures, and 3 (15%) died. Eight neonates (40%) had hyperbilirubinemia (mean total bilirubin, 13.1±7.4). The mean follow-up period was 8.4±7.5 months. At follow-up, 10 neonates (58.8%) were healthy with normal development, whereas 7 (41.2%) had neurological deficits. CONCLUSION: The morbidity rate was 41.2% due to severe metabolic acidosis. Anemia, hyperbilirubinemia, low Apgar scores, and subdural hemorrhage did not affect the prognosis. The long-term outcomes of neonates with SGH are generally good. Only arterial blood pH was significantly associated with death.

Vacuum extraction vaginal delivery: current trend and safety

Operative vaginal birth retains an important role in current obstetric practice. However, there is an increasing trend in the rate of cesarean section in Korea. Surgical delivery is more advantageous than cesarean section, but the rate of operative vaginal delivery is decreasing for various reasons. Furthermore, there is no unified technique for vacuum extraction delivery. In this context, this review was performed to provide details of the necessary conditions, techniques, benefits, and risks of operative vaginal delivery. Future research should focus on overcoming the limitations of operative vaginal delivery.

Study on Vacuum Extraction Technology ofSophora Alopecuroides / 世界科学技术-中医药现代化

This study was aimed to optimize the vacuumextraction technology of alkaloids fromSophora alopecuroides. The orthogonal test and comprehensive evaluation were used to optimize the vacuumextraction technology. Contents of total alkali and oxymatrinewere used as index components for optimizing the effect of three factors, which were the adding amount of water, extraction time, and extraction frequency. Comparison was made among optimal conventional extraction process, decoction extraction and vacuumextraction. The results showed that the optimum extraction process was to add 12 times amount of water, and to extract for 3 times under the temperature of 60℃, 1h for each time. It was concluded that the optimized extraction vacuum technologyof alkaloids fromS. alopecuroidsdecompression total alkali content and oxymatrine process was better than that of optimal conventional extraction process and decoction extraction. The vacuumextraction technology was stable and practical.

A Floppy Baby with Congenital Myotonic Dystrophy Complicated with Huge Subgaleal Hematoma Occurring in Non-instrumental Vaginal Delivery

Not only is the concurrence of congenital myotonic dystrophy (CDM) and subgaleal hematoma (SGH) hardly ever seen but also the development of SGH during unassisted vaginal delivery is rare. We report a boy who developed huge SGH in vaginal delivery without any use of vacuum or forceps and later was diagnosed as maternally transmitted CDM. The boy had prenatal history of polyhydramnios and decreased fetal movement. Six hours after birth, severe molding of the skull associated with huge SGH on left parieto-occipital area was recognized by CT scan. At corrected age of two months, he was diagnosed as maternally transmitted CDM. This is the first report of CDM complicated by SGH occurring in non-instrumental vaginal delivery.

Trends in modes of delivery in Siriraj Hospital.

Objective: To determine the changing of trend in methods of delivery in a university hospital, the correlation among each method of delivery as well as the correlation of the cesarean section rates and the perinatal mortality rates. Methods: The medical records of birth in Siriraj Hospital during 1979-2006 were collected and analyzed. The methods of delivery from these data were grouped and categorizes as following : vaginal delivery, cesarean section, forceps extraction, vacuum extraction, vaginal breech delivery and others. Each method of delivery was studied separately in detail for time and accordingly trend and comparatively to the others to find interaction among them. The changing of trend of perinatal mortality rates were also demonstrated to identify the correlation with the cesarean section rate. Results: There were totally 442,635 births for this study. It was found that the percentage of vaginal delivery was decreased from 82.35 % in 1979 to 58.44 % in 2006 while the cesarean section rates was increased steadily from 7.06% in 1979 to 37.77 % in 2006. The other methods of delivery such as forceps extraction, vacuum extraction and vaginal breech delivery do not play significant roles in this changing trend since they have only small proportions ranging from about 2-5% of all deliveries. In the view of perinatal mortality rate , it continuously declined and has been less than 10% in the last 10 years. Conclusion: Regarding to 28-year review, it is clearly established that methods of delivery are now changing. Cesarean section rate rises steadily with unpromising sign of stabilization and is now far beyond the rate suggested by WHO. It directly effects the downward trend of vaginal delivery and also may be to the other methods of delivery such as vaginal breech delivery, forceps extraction and vacuum extraction, approaching the extinction. This study found no significant correlation between the increasing cesarean rates and the perinatal mortality rates.

A case of scalp abscess caused by Achromobacter xylosoxidans after vacuum delivery / 소아과

Achromobacter xylosoxidans is an aerobic gram-negative bacillus that may cause opportunistic infections in immunocompromized patients and newborns. Neonatal scalp abscess is generally a complication of fetal scalp monitoring and is typically polymicrobial. We present a case of a newborn, delivered by vacuum extraction, who developed a scalp abscess that yielded growth of Achromobacter xylosoxidans.

Survey of Mental Development on 100 Cases of Vacuum Extraction / 昆明医科大学学报

In this study, the mental development of 100 childien with vacuum extraction has been surveyed. The results show that Vacuum extraction does not influence the mental development of children, but fetal distress and the second stage of labor prolonged can influence the mental development.