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Re: Forceps/VacuumFrom: ainsron (ainsron@sbcglobal.net)Tue Mar 16 09:43:46 2004
It was in the March 1 Ob/Gyn News, I've also seen it recommended by others: Think FORCEPS Before Operative Vaginal Delivery Sherry Boschert San Francisco Bureau MAUI, HAWAII - The mnemonic FORCEPS can remind you of prerequisites for attempting an operative vaginal delivery, Dr. Michael Belfort said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law. To make sure conditions are favorable for a vacuum or forceps extraction, run through the letters in FORCEPS, advised Dr. Belfort, director of maternal fetal medicine and professor of obstetrics and gynecology at the University of Utah, Salt Lake City. F: The fetus is in a favorable head position, and you've done an assessment of fetal weight and status. O: The patient has an open os, and the operating room is ready if needed. He defined an open os as a completely dilated cervix. "Even with the most basic outlet forceps, I always will say, 'Are we ready to go in the OR in case we need it?'" he said at the meeting, sponsored by Boston University and the Center for Human Genetics. R: Membranes are ruptured, and the patient qualifies for operative vaginal delivery under the rule of threes, defined in a 1982 article: "In an OA [occiput anterior] presentation, if the sum of the number of fifths of the fetal head palpated above the pelvic inlet abdominally and the degree of molding of the fetal head palpated vaginally equals or exceeds three, then attempted operative vaginal delivery is likely to be unsuccessful and should be avoided." C: Contractions are present, and the patient has given consent for operative vaginal delivery. There is no standard of care for obtaining patient consent in these cases, Dr. Belfort noted. "I encourage you to get written consent in every elective case where you have time," he said, and in emergency cases, at least get verbal informed consent. When possible, provide detailed materials during a prenatal consultation; answer the mother's questions and try to allay her fears. Inform her of alternatives such as watchful waiting or cesarean section, and the potential risks and benefits of each. Document that the mother understands that she can change her mind at any time. E: The fetal head is engaged, the maternal bladder is empty, and the mother has an epidural or other anesthesia on board. P: The maternal pelvis is adequate for operative vaginal delivery, you have prepared for C-section, a pediatrician is available, and you've written a preoperative note. S: This stands for stirrups, a reminder to check that the patient is in the lithotomy position with her buttocks over the end of the bed. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of RModugno@aol.com Sent: Tuesday, March 16, 2004 8:35 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Forceps/Vacuum In a message dated 3/16/04 11:00:07 AM Eastern Standard Time, ainsron@sbcglobal.net writes: I've read the suggestion that anytime one applies forceps or vacuum, he should have written a preop note and called in the OR crew in case he needs to move directly to Cesarean section and always to have the pediatrician present. Ron, can you remember where you read this preposterous (my opinion) suggestion? Robert Modugno MD MBA FACOG marietta, GA http://www.novaobgyn.yourmd.com
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