Re: Forceps/Vacuum
From: Charlie Chambers (cchamber@gorge.net)
Tue Mar 16 18:38:50 2004
Dr. Dwight Cruikshank beat into my brain that you are attempting a
"trial of forceps" and the indication for C/S was "unsuccessful
forceps". I thought the reasoning made sense 1) not good to be writing
"failed'" in the chart, 2) keeps you in the right attitude that even
the most apparently easy forceps should not use excessive traction or
attempts. We always wrote trial of forceps regardless of the perceived
difficulty.
************************************************************************
*
Charlie Chambers
--
Hood River, OR
cchamber@alumni.rice.edu
"No matter where you go...
there you are."
Dr. Buckaroo Banzai
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On Mar 16, 2004, at 4:59 PM, Garry E. Siegel, M.D. wrote:
> Great item for discussion, with several issues.
>
> 1. Agree that indications, EFW, clinical pelvimetry, etc. should be
> assessed, discussed (verbal informed consent)and documented. While I
> may write a brief pre-delivery note as to why I'm proceeding to an
> operative vaginal delivery, the details are in the dictated (and I
> dictate ALL deliveries) note.
>
> 2. I don't at all agree that the OR crew should be standing by. Glen
> points out something I do, which is when I think there is a chance that
> the forceps won't work, or if it is "iffy" as to whether it will or
> won't, then I do the procedure in an OR (not an LDR) with an MD
> Anesthesiologist or CRNA there or closeby/dedicated, as well as the
> proper folks to scrub for a section if needed. I seem to recall that
> outcomes are better after unsuccessful forceps if the section is
> immediate.
>
> 3. What wording do you guys use, i.e. trial forceps, attempted
> forceps, failed forceps, unsuccessful forceps, etc. I have heard that
> writing "failed" anything isn't such a good idea! I also have
> heard/recall that failed forceps connotes (I may be mistaken) lack of
> application rather than failure to deliver. Also, trial implies your
> confidence level is lower than "regular" forceps, although I've also
> seen somebody say ALL forceps are trials. Normally, I call a trial
> forceps when I do it in the OR and have the crew handy.
>
> Garry
>
> At Tue, 16 Mar 2004, Elrod Glen Maj 3 MDG/SGOB wrote:
>>
>> Exactly the same, unless I am trying a "trial forcep" where I am not
>> sure of
>> my success with forceps. It just doesn't make any sense to write a
>> note
>> before hand.
>>
>> Did someone there bring this up as a problem?
>>
>> Glen
>>
>> D. Glen Elrod, Maj, USAF, MC
>> Medical Director
>> Women's Health Center
>> Elmendorf AFB, AK 99506
>>
>> -----Original Message-----
>> From: ainsron@sbcglobal.net [mailto:ainsron@sbcglobal.net]
>> Sent: Tuesday, March 16, 2004 7:00 AM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Forceps/Vacuum
>>
>> 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. Personally,I've never made a point of writing a
>> note beforehand, I always put the indications and discussion with the
>> patient in my delivery note both written and dictated. Neither have I
>> routinely called in the OR crew to standby when I'm preparing for
>> vacuum
>> or forceps. I do tell the patient that if this procedure does not
>> proceed smoothly, we may need to move to the OR and deliver by
>> cesarean
>> section. In my experience, the decision for instrumental delivery
>> occurs in the process of the delivery when I am already scrubbed in.
>> To
>> break scrub to write a note would be a waste of time, especially if
>> I'm
>> doing it because of the development of a non-reassuring FHR pattern
>> and
>> feel that application of the vacuum can deliver the baby in a short
>> period of time. What do others do?
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
