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2 results

  • 4 - THE MISSING CHAPTER? PROLONGED LABOUR AND OBSTETRIC TRAUMA

  • James Owen Drife, University of Leeds, Gwyneth Lewis, University College London, James P Neilson, University of Liverpool, Marian Knight, National Perinatal Epidemiology Unit, Oxford, Griselda Cooper, University of Birmingham, Roch Cantwell, Southern General Hospital, Glasgow
  • Book:
    Why Mothers Died and How their Lives are Saved
    Published online:
    05 April 2023
    Print publication:
    30 March 2023, pp 52-62

  • Summary

    In 1952-4 the caesarean section rate was under 2% and many women died of complications of vaginal birth. The Report listed 190 deaths in an appendix under various causes including 'contracted pelvis', once common due to rickets. Pelvic measurement was part of antenatal care. In doubtful cases 'trial of labour' often ended in forceps delivery. A 10% fetal loss rate was considered acceptable. Home births could end in forceps delivery by GPs who had no postgraduate training and relied on their student experience. In the 1955-7 Report, 33 women died after forceps delivery at home or in a maternity home. In the 1960s 'prolonged labour' (> 24 hours) was blamed on 'inco-ordinate uterine action'. In 1969 in Dublin Kieran O’Driscoll introduced 'active management' for first-time mothers in hospital, showing that normal labour could safely be achieved with an intravenous oxytocin 'drip'. Early CEMD Reports criticised GPs but in the 1960s their comments became more constructive. The BMJ ran a series of articles, 'Obstetrics for GPs', written by leading obstetricians. By the late 1970s only 2% of births were home deliveries and the Reports no longer discussed place of birth.

  • 35 - Neonatal resuscitation and the management of immediate neonatalproblems

  • from Section 7 - NeonatalEmergencies and Resuscitation
  • Edited by Edwin Chandraharan, Sabaratnam Arulkumaran
  • Book:
    Obstetric and Intrapartum Emergencies
    Published online:
    05 November 2012
    Print publication:
    11 October 2012, pp 241-249

  • Summary

    Instrumental vaginal deliveries can be hazardous in inexperienced hands and should be undertaken with due care and supervision. In cases of fetal distress it is essential that the instrumental delivery be straight forward as the combination of trauma and hypoxia is potentially damaging to the fetus. In general, ventouse delivery is preferred when the position is occipitotransverse or occipito-posterior to allow for autorotation of the fetal head during traction unless the accoucher is experienced in Kielland's rotational forceps delivery. Where maternal expulsive efforts may be compromised, forceps may be better than ventouse delivery. Maternal complications are higher with forceps whilst neonatal complications are more common with the use of ventouse. Although instrumental delivery is a service provided in both basic and comprehensive essential obstetric care, it is under-used in low-resource settings. After delivery, an adequate review of overall conduct of the delivery, perineal repair and postpartum care should follow.