Artículo
Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?
Autor/es | García Mejido, José Antonio
Martín-Martínez, A. González-Diaz, E. Fernández-Fernández, C. Ortega, I. Medina, M. Fernández-Corona, A. Fernández Palacín, Ana Sáinz Bueno, José Antonio |
Departamento | Universidad de Sevilla. Departamento de Cirugía Universidad de Sevilla. Departamento de Medicina Preventiva y Salud Pública |
Fecha de publicación | 2019 |
Fecha de depósito | 2024-01-25 |
Publicado en |
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Resumen | Objective
To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for ... Objective To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. Methods This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. Results In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36–3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95–4.85); P = 0.068). Conclusion When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. |
Cita | García Mejido, J.A., Martín-Martínez, A., González-Diaz, E., Fernández-Fernández, C., Ortega, I., Medina, M.,...,Sáinz Bueno, J.A. (2019). Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?. Ultrasound in Obstetrics and Gynecology, 55 (2), 257-263. https://doi.org/10.1002/uog.20404. |
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