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Re: Forceps/VacuumFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Mar 17 04:48:11 2004
According to Williams 12th edition P 1154 Trial means that "the operator attempts a midforceps del. With the full realization that a certain degree of disproportion at the mid pelvis may make the procedure incompatible with safe outcome for the child. After a good application has been achieved, several firm, downward pulls on the instrument are made, and if no descent whatsoever occurs, the procedure is abandoned and cesarean resorted to." Ref is made to Douglass. "Failed forceps is applied to the case where an all out attempt has been made to deliver the with forceps but without success. The three factors responsible for such cases are disproportion, incomplete cervical dilation, and some malposition fo the fetal head usually an unrecognized occiput posterior position. Most, but not all such cases stem from inexperience and gross ignorance of obstetric fundamentals." I have found that it is best not to apply adjectives to things like this for they may not mean what you think they mean. I like to just describe in my note exactly what happened and let it go at that. The use of the word, Inadvertent, is a good example. E.g. "The ureter was inadvertently transected". The word inadvertent actually means "without paying attention". Do you want your op note to say you were looking the other way when you cut the ureter? I think not Dan "Sound is like water. If you drill one hole in the wall the sound will leak right through." - JAY BRAUN, a band member by love, a soundproofer by necessity. -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. Siegel, M.D. Sent: Tuesday, March 16, 2004 8:00 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Forceps/Vacuum 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:
>
>should have written a preop note and called in the OR crew in case he
-- Garry E. Siegel, M.D. Private Practice Roswell, GA
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