==================================HSR25==================================
25.   Birth injury related to mid-forceps deliveries (in a 24 year old).
      (The injury is traumatic neurologic injury involving the right
      parietal lobe, and may also include panencephalopathic neurologic
      injury from perinatal asphyxia). Fetal position- left occiput 
      posterior.
1
UI  - 87127825
AU  - Ngan HY ; Tang GW ; Ma HK
TI  - Vacuum extractor: a safe instrument?
AB  - One thousand five hundred and twenty-six records of deliveries with
      vacuum extractor in 1982 and 1983 in the Hong Kong University Department
      of Obstetrics and Gynaecology were reviewed. Vacuum extractor was found
      to be easy and safe to use even by inexperienced house-staff. Vacuum
      extractor was especially useful in the delivery of malpositioned fetal
      heads because of its mechanism of allowing autorotation. Its advantage of
      not occupying extra space in the pelvis was most beneficial to the
      relatively smaller Chinese pelvis. Maternal injury was uncommon. Fetal
      scalp injury like cephalhaematoma was not uncommon but serious scalp
      injury was infrequent. Perinatal mortality rate attributed to the
      instrument was low (0.6/1,000). However, in order to achieve safety to
      the mother and fetus, strict rules in application of the vacuum extractor
      must be observed.
MH  - Apgar Score ; Asphyxia Neonatorum/ETIOLOGY ; Birth Injuries/ETIOLOGY ;
      Birth Weight ; Extraction, Obstetrical/*INSTRUMENTATION ; Female ;
      Hemorrhage/ETIOLOGY ; Human ; Infant, Newborn ; Jaundice, Neonatal/
      ETIOLOGY ; Pregnancy ; Vacuum Extraction, Obstetrical/ADVERSE EFFECTS/
      *INSTRUMENTATION ; Vagina/INJURIES
SO  - Aust NZ J Obstet Gynaecol 1986 Aug;26(3):177-81
2
UI  - 86301427
AU  - Ben-Ari Y ; Merlob P ; Hirsch M ; Reisner SH
TI  - Congenital depression of the neonatal skull.
AB  - Congenital depression of the neonatal skull has had an incidence of 0.1%
      (1/10 000) in our newborn population during the past 8 years. These skull
      depressions have two pathogenetic types: deformation without fracture and
      fracture accompanied by depression. The cause of skull depression being
      the pressure exerted by the digits and fist of the newborn on his skull
      has not been previously reported. The treatment of choice for selected
      cases is nonsurgical elevation with an obstetric vacuum extractor. A CT
      scan should be performed prior to this treatment to rule out intracranial
      complications such as hemorrhage.
MH  - Birth Injuries/ETIOLOGY ; Case Report ; Female ; Human ; Infant, Newborn
      ; Obstetrical Forceps/ADVERSE EFFECTS ; Pressure ; Skull/*ABNORMALITIES ;
      Skull Fractures/*CONGENITAL/THERAPY
SO  - Eur J Obstet Gynecol Reprod Biol 1986 Aug;22(4):249-55
3
UI  - 86294643
AU  - Szymonowicz W ; Yu VY ; Walker A ; Wilson F
TI  - Reduction in periventricular haemorrhage in preterm infants.
AB  - Our previous cerebral ultrasound study of antecedents of periventricular
      haemorrhage in infants weighing 1250 g or less at birth suggested that
      neonatal events that caused increased or fluctuating cerebral blood flow
      lead to periventricular haemorrhage. As the risk period for this type of
      haemorrhage was the first four days of life strict guidelines were
      introduced to avoid the previously identified neonatal risk factors. No
      attempt was made to modify obstetric practice. Over the next two years,
      although the obstetric risk profile, the frequency and severity of
      hyaline membrane disease, and the gestation, birth weight, and sex
      distributions of a similar cohort of infants did not change, the
      incidence of periventricular haemorrhage decreased significantly from 60%
      to 36%. Significant antecedents of haemorrhage similar to those found in
      the previous study included severe bruising, low arterial:fractional
      inspiratory oxygen ratio and low packed cell volume on admission, hyaline
      membrane disease, hypercarbia, and hypoxaemia. Assisted ventilation,
      pneumothorax, treatment with tubocurarine, and hypotension were no longer
      significant risk factors for periventricular haemorrhage. A multivariate
      discriminant analysis correctly predicted haemorrhage in 86% of the study
      group when bruising, hypercarbia, hypoxaemia, hyaline membrane disease,
      and low gestation were considered. These results suggest that changes in
      neonatal practices can reduce the incidence of periventricular
      haemorrhage and that drug studies indicating similar reduction in
      haemorrhage need to be evaluated carefully to ensure that placebo and
      treated groups are in fact comparable.
MH  - Birth Injuries/COMPLICATIONS ; Cerebral Hemorrhage/ETIOLOGY/*PREVENTION &
      CONTROL ; Delivery ; Female ; Human ; Infant, Newborn ; Infant,
      Premature, Diseases/*PREVENTION & CONTROL ; Labor ; Pregnancy ;
      Prospective Studies ; Risk
SO  - Arch Dis Child 1986 Jul;61(7):661-5
4
UI  - 86280998
AU  - Carmody F ; Grant A ; Somchiwong M
TI  - Vacuum extraction: a randomized controlled comparison of the New
      Generation cup with the original Bird cup.
AB  - A new design of vacuum extractor cup--'the New Generation cup'--has
      recently been introduced into clinical practice. Its major modification
      is a traction cord which passes around the rim of the cup for 180 degrees
      and is free to slide within the rim. Claims that this design 'enables the
      operator to pull obliquely without causing the cup to tilt' and thereby
      'reduces failure rates, reduces the incidence of scalp trauma and
      increases operator confidence' have been evaluated in a randomized
      controlled trial. 123 women with singleton pregnancies of 37 completed
      weeks or more, with a cephalic presentation and for whom a decision to
      deliver by vacuum extraction had been taken, were randomly allocated to
      the 'New Generation' cup or BIRD's original vacuum extractor cup; 50 mm
      anterior and posterior cups were used in both groups as appropriate. The
      two groups were comparable at entry and delivered by obstetricians of
      similar status. The two types of cup were similar in respect of number of
      failures to deliver with the vacuum extractor, correct positioning of the
      cup, number of pulls required for delivery and time taken to expedite
      delivery. Cup detachments occurred in nine cases allocated to the 'New
      Generation' cup compared with four allocated to the original BIRD cup.
      The babies in the two groups were in similar condition at birth and
      sustained similar amounts of scalp trauma. Neonatal jaundice, both
      clinical and biochemical, was more common in babies delivered with the
      'New Generation cup' and this was reflected in greater use of
      phototherapy in this group. Operators were equally divided in their
      preference of cup.(ABSTRACT TRUNCATED AT 250 WORDS)
MH  - Adult ; Birth Injuries/ETIOLOGY ; Comparative Study ; Evaluation Studies
      ; Extraction, Obstetrical/*INSTRUMENTATION ; Female ; Human ; Infant,
      Newborn ; Infant, Newborn, Diseases ; Pregnancy ; Random Allocation ;
      Vacuum Extraction, Obstetrical/ADVERSE EFFECTS/*INSTRUMENTATION/MORTALITY
SO  - J Perinat Med 1986;14(2):95-100
5
UI  - 86280997
AU  - Krieglsteiner P ; Krone HA ; von Zeppelin D
TI  - Experience with the Bamberg obstetrical forceps.
AB  - The design and use of a divergent obstetrical forceps, which was
      developed at the Staatliche Frauenklinik und Hebammenschule in Bamberg by
      Sipli and Krone are presented. The major advantage associated with the
      use of this instrument is that it permits the exertion of a limited
      constant application force (max 300 g) on the fetal head. Thus,
      compression injuries are effectively prevented and slippage of the
      forceps with resultant trauma is precluded. The Bamberg forceps was
      evaluated at the Frauenklinik und Poliklinik der Technischen Universit:at
      M:unchen and at the Staatliche Frauenklinik und Hebammenschule Bamberg,
      Federal Republic of Germany. An evaluation of 483 cases where this
      forceps was used is presented. No serious complications directly
      attributable to the use of this instrument could be documented.
MH  - Apgar Score ; Birth Injuries/ETIOLOGY ; Equipment Design ; Female ; Fetal
      Distress ; Human ; Infant, Newborn ; *Obstetrical Forceps/ADVERSE EFFECTS/
      UTILIZATION ; Pregnancy ; Vacuum Extraction, Obstetrical/UTILIZATION
SO  - J Perinat Med 1986;14(2):87-93
6
UI  - 86183937
AU  - Dierker LJ Jr ; Rosen MG ; Thompson K ; Lynn P
TI  - Midforceps deliveries: long-term outcome of infants.
AB  - Infants delivered by midforceps between 1976 and 1982 were evaluated for
      evidence of developmental delay or neurological deficit by chart review.
      The 110 infants who were followed for at least 2 years were compared to a
      matched group of infants delivered by cesarean section. The cesarean
      section group was matched for the immediate indication for delivery
      (dystocia or fetal distress), birth weight, gestational age, sex, and
      race. There was no significant difference in abnormal outcomes in the two
      groups.
MH  - Birth Injuries/ETIOLOGY/*OCCURRENCE ; Cesarean Section/ADVERSE EFFECTS ;
      Child ; Child Development Disorders/ETIOLOGY/*OCCURRENCE ; Child,
      Preschool ; Female ; Follow-Up Studies ; Human ; Infant ; Infant
      Mortality ; Infant, Newborn ; Nervous System Diseases/ETIOLOGY/
      *OCCURRENCE ; Obstetrical Forceps/*ADVERSE EFFECTS ; Ohio ; Pregnancy ;
      Retrospective Studies
SO  - Am J Obstet Gynecol 1986 Apr;154(4):764-8