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Re: Forceps/VacuumFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Wed Mar 24 04:44:54 2004
At Tue, 16 Mar 2004, Dr. Ainsworth wrote: > >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? We could also write a note every 5 min durring the second stage but that would actually keep us from attending the patient durring the second stage. As for trial of forceps and calling in anaesthsesia and peds well maybe clinical judgement has some role to play there. Well I got to run to do a trial of foceps in a mom who has been fully dialated for the last 4 hrs. Clinical pelvemitry?, is that better than X-ray Pelvimetry.
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Take care, John
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