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Re: Forceps/VacuumFrom: ainsron (ainsron@sbcglobal.net)Wed Mar 17 07:45:09 2004
Ronald E. Ainsworth -----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 5:00 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. I normally dictate in my admission H&P the estimated fetal weight and whether or not I feel the pelvis is "adequate." When was the last time any of us recorded that we were admitting a patient for labor and that the pelvis was "inadequate?" Borderline perhaps, but if I truly thought it was inadequate, why didn't I simply do C/S? [says the attorney in court.] Clinical pelvimetry is recorded in my initial OB H&P which should be on the chart when the patient is admitted. Unless either "changes" in labor, I see no point in re-recording them. 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. I agree. 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. I dictate it as a trial of forceps/vacuum if I'm in the OR. If it fails, whether or not I am in the OR I call it failed forceps/vacuum. I don't think calling it what it is should be inappropriate. Its kind of like the debate over calling a FHR tracing fetal distress or "non-reassuring," it is what it is. Calling a cat a dog does not make it one.
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