Exploring the newborn head diameters in relation to current obstetric forceps' dimensions: A systematic review.

OBJECTIVE: The aim of this study was to systematically search the literature for studies that reported term neonate head size and shape, in an attempt to determine the most appropriate dimensions for the obstetric forceps. STUDY DESIGN: We searched the Ovid Medline, Ovid Embase and Ebscohost CINAHL databases from inception to February 2016. We predefined inclusion criteria to identify studies in which head width and length of asymptomatic, term neonates were measured soon after birth using direct, non-photographic methods A bespoke quality assessment score was used to evaluate the identified studies. RESULTS: Seven studies were identified which measured head width (biparietal diameter) in 551 neonates; giving a mean value of 94.0mm (range 90.7mm-95.5mm). We identified one study which measured head length (mentovertical diameter) in 38 neonates; which gave a mean value of 134.5mm (range 129mm-139mm). CONCLUSION: This data, in conjunction with measurements of Neville Barnes' and Wrigley's forceps from our previous study, indicates current obstetric forceps' blades are too long, and close together. Potentially, this could be contributing to neonatal and maternal injuries associated with operational vaginal deliveries.

The role of ambulatory urodynamics in investigation of female urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Lower urinary tract symptoms (LUTS) impact upon quality of life and occur in women of all ages. The National Institute for Clinical Excellence states that ambulatory urodynamic monitoring (AUM) should be used as a second-line investigational modality; however, its use is becoming more frequent. AUM provides a valid second line to conventional urodynamic methods that may be more widely used. METHOD: A literature review was undertaken to assess evidence for the use of AUM alongside a retrospective review of patients undergoing AUM at a tertiary care centre and symptom reporting at a follow-up visit. Both these methods included evidence for pathology detection, technical ease of use, recreation of symptoms and patient experience, allowing comparison of literature results to those experienced in day-to-day use. RESULTS: The literature shows AUM to have sensitivity superior to that of other urodynamic investigations. However, evidence suggests this correlates less well with clinical effectiveness. Patients felt AUM was superior in recreating their symptoms, and they tolerated the procedure well. The increased technical demands of AUMs, however, meant that traces were more commonly harder to interpret than with conventional urodynamics. Our experience correlates well with the existing literature, suggesting increased symptom diagnosis; 63.2 % of diagnoses correlated well with symptoms. CONCLUSION: AUM remains an important urodynamic method to supplement conventional urodynamics. Evidence suggests it is superior in LUTS diagnosis, but its technical difficulty can affect results.