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.
Cesarean Section ; Delivery, Obstetric ; Female ; Korea ; Parturition ; Pregnancy ; Vacuum Extraction, Obstetrical ; Vacuum*

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.
Infant, Newborn ; Pregnancy ; Humans ; Female ; Cesarean Section ; Retrospective Studies ; Vacuum Extraction, Obstetrical/adverse effects* ; Hospitals, General ; Obstetrical Forceps/adverse effects* ; Delivery, Obstetric

OBJECTIVE: The objective of this study was to compare the neonatal outcomes and intrapartum events conducted by staff versus resident physicians in full term vaginal deliveries. METHODS: We divided study population (n = 5,007) into two groups: staff versus resident physicians. These two groups were sub-divided; faculty versus fellow and senior versus junior resident, respectively. The maternal characteristics, neonatal outcomes including Apgar score, admission to the neonatal intensive care unit and umbilical arterial pH and intrapartum event which was defined as the occurrence of shoulder dystocia and vacuum delivery were also investigated. RESULTS: There was no difference in neonatal outcomes between two groups. The group delivered by staff had a higher rate of nulliparity, large for gestational age and intrapartum events than the resident physician group. The subgroup analysis revealed a higher rate of vacuum delivery in the group delivered by faculty and senior members than the group delivered by fellows and junior members. CONCLUSION: There was no significant difference in neonatal outcomes between the two groups; staff versus resident physicians in full term vaginal deliveries in low-risk pregnant women. Also, experienced obstetricians might tend to participate in difficult labors and would prefer applying vacuum compared to the obstetricians with fewer experiences.
Apgar Score ; Delivery, Obstetric* ; Dystocia ; Female ; Gestational Age ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn ; Intensive Care, Neonatal ; Parity ; Pregnancy ; Pregnant Women ; Shoulder ; Vacuum Extraction, Obstetrical

Cesarean section rate has a tendency to get higher. Premature rupture membranes has high prevalence, low percentage of vaginal deliveries in breech presentation, anterior cesarean section contribute to rise the cesarean section rate. We focus on the premature rupture membranes to reduce this rate in the coming years.
Delivery, Obstetric ; Cesarean Section

INTRODUCTION: This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes. METHODS: A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes. RESULTS: Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar. CONCLUSION More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Adult ; Cesarean Section ; methods ; statistics & numerical data ; Databases, Factual ; Delivery, Obstetric ; Emergency Medical Services ; Extraction, Obstetrical ; methods ; statistics & numerical data ; Female ; Humans ; Labor Stage, First ; Labor Stage, Second ; Obstetrical Forceps ; Pregnancy ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult

OBJECTIVES: Vaginal birth or trial of labor after previous cesarean section has become one of the most remarkable changes in obstetric practice. The safety and efficacy of a trial of labor and vaginal birth after previous cesarean are well documented. The purpose of this report is to predict the likelihood of vaginal birth in patients undergoing a trial of labor after previous cesarean delivery using factors known at the time of hospital admission. METHOD: In this retrospective study, 120 women who attempted vaginal birth at Kyung-Hee University Hospital from March 1997 to March 1999. An attempt to identify possible prognostic factors for success of such a trial was made and we evaluated the variables of significant predictive value and the patients' characteristics in the success group and failure group of women who attempted VBAC. RESULT: 87 cases(72.5%) in 120 cases succeeded in VBAC and 33 cases(27.5%) failed. In this comparative groups in VBAC, there was significant difference in CPD index(cephalopelvic disproportion index) and Bishop score, but no significant difference in gestational age, the estimated fetal weight by sonography and newborn birth weight. CONCLUSION: In this study, Bishop score and CPD index and age may be useful and valid predictor of success in VBAC and this information could be particularly valuable. The CPD index may prove most important in determining if a vaginal birth should occur after a cesarean section because it can clearly identify some patients who need a repeat cesarean section.
Birth Weight ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Fetal Weight ; Gestational Age ; Humans ; Infant, Newborn ; Parturition ; Pregnancy ; Retrospective Studies ; Trial of Labor ; Vaginal Birth after Cesarean*

During July 2002 to December 2003, there were 1618 eligible pregnant women attending to delivery at National Hospital for Obstetric and Gynecology recruited for the study. The rate of CS was 32.4% (16.5% elective CS and 15.8% emergency CS). There is an increase in the rate of having minor wound infection and higher in emergency CS (9.4%). The rate of maternal death was also higher in the group of emergency CS of 3.9/1000, while those rates in elective CS and vaginal were zero. No significant difference of neonatal complications was found among three groups (p>0.08). Medical cost occupied a large part of total bill spent for a delivery (78.1%)
Delivery, Obstetric

Repeat cesarean section is one of the leading causes to make increasing a rate of cesarean section. Trial of labor TOL after cesarean section is attempt to reduce the rate of repeat cesarean section. Trial of labor has been well established as a safe alternative in carefully selected women with transverse scars in the lower uterine segment. This study was based on 104 cases of delivery with prior cesarean birth at the Chonbuk National University Hospital from January, 1991 to June, 1997. The results were as follows: 1) Among 1400 cases with previous cesarean delivery, trial of labor was done in 104 cases (7.4%). Among 104 cases, vaginal birth was successfully completed in 96 cases (92.3%). 2) Among 28 cases with PGE2, vaginal tablet, vaginal delivery was done in 23 cases (82.1%). 3) Among 22 cases with more than 4 of Bishop score, vaginal delivery was done in 21 cases (95.5%), and among 6 cases with less than 3 of Bishop score, vaginal delivery was done only 2 cases (33.3%). 4) There was no matemal death or uterine rupture in the cases of trial of labor, But in 2 cases, uterine dehiscence was observed in 4 cases and postpartal bleeding (more than 400ml) was developed. 5) In the cases of cesarean section, mean of hospital day was 7 days and medical fee was about 400,000 won. In the cases of vaginal birth after cesarean section, mean of hospital day was 2.6 days and medical fee was about 100,000 won. In condusion, vaginal birth after cesarean section is safe and effective alternative to elective repeat cesarean section and also the use of PGE, vaginal tablet is so effective to increase success rate of vaginal delivery. After all, positive these trials might decrease cesarean rate and increase maternal health and quality of medical care.
Cesarean Section ; Cesarean Section, Repeat ; Cicatrix ; Dinoprostone ; Fees, Medical ; Female ; Hemorrhage ; Humans ; Jeollabuk-do ; Maternal Health ; Parturition ; Pregnancy ; Prostaglandins E ; Trial of Labor ; Uterine Rupture ; Vaginal Birth after Cesarean* ; Vaginal Creams, Foams, and Jellies

Vesicouterine fistula, a fistula between bladder and uterus, is one of the rarest urogenital fistula. Most cases are associated with repeat Cesarean section and with vaginal birth after Cesarean section (VBAC). During Cesarean section, it is important to dissect and move the bladder away from uterus carefully, especially in case of adherent bladder to the anterior vaginal wall or lower segment wall and it is necessary to explain the possibility of vesicouterine fistula development in case of VBAC. Patients usually present with urinary incontinence in the early postoperative period or present months or years later with cyclic hematuria, amenorrhea, vaginal leakage of urine, urinary tract infection and secondary infertility. The diagnosis is made by cystoscopic visualization of the fistula orifice in the bladder and outlining the fistula tract on cystogram, hysterosalpingogram or transvaginal ultrasonogram. There have been varied approaches to the treatment of vesicouterine fistula with conservative therapy or surgical therapy. We experienced two cases of vesicouterine fistulas in women with previous Cesarean section, the one is delivered with repeat Cesarean section after trying VBAC, the other is delivered with vacuum assisted VBAC, and treated with surgical repair.
Amenorrhea ; Cesarean Section* ; Cesarean Section, Repeat ; Diagnosis ; Female ; Fistula* ; Hematuria ; Humans ; Infertility ; Postoperative Period ; Pregnancy ; Ultrasonography ; Urinary Bladder ; Urinary Incontinence ; Urinary Tract Infections ; Uterus ; Vacuum ; Vaginal Birth after Cesarean

OBJECTIVE: Recently, with rising rates of repeat cesarean sections, enormous amount of the studies about trial of labor after cesarean section have been reported to decrease the rate of cesarean section. The purpose of this study is to provide data regarding the safety and the successful prognostic factors of VBAC (vaginal birth after cesarean section). METHODS: This retrospective study was performed based on 194 pregnant women who tried vaginal delivery after cesarean section at Eulji University Hospital from March 1997 to February 2002. The age of mother, gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical effacement, cervical dilatation, Bishop score, the number of previous vaginal delivery, and spontaneous labor were analyzed between successful group (177 patients) and failure group (17 patients) with trial of labor. Student T-test and Chi-square test were used for statistical analysis. RESULTS: 177 cases (91.24%) in 194 cases succeeded in VBAC and 17 cases (8.76%) failed. There was no maternal death or uterine rupture in the cases of trial of labor. The gestational age, estimated fetal body weight by ultrasonography, neonatal body weight, cervical effacement, cervical dilatation, Bishop score, the number of previous vaginal delivery, spontaneous labor had notable differences between the successful group and the failure group. But, There was no significant difference in maternal age. CONCLUSION: The trial of labor after cesarean section is relatively safe method of delivery if it is performed under strict indication. Above findings can be used as possible prognostic factors for the success of VBAC and may reduce the risk and complication of VBAC. The following studies with large populations and performed by multi-centers will be needed for the evaluation of safety and successful prognostic factors of VBAC.
Body Weight ; Cesarean Section ; Cesarean Section, Repeat ; Female ; Fetal Weight ; Gestational Age ; Human ; Humans ; Labor Stage, First ; Maternal Age ; Maternal Death ; Parturition ; Pregnancy ; Pregnant Women ; Retrospective Studies ; Surrogate Mothers ; Trial of Labor ; Ultrasonography ; Uterine Rupture ; Vaginal Birth after Cesarean*