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Re: Vacuum extraction in preemies under 34 weeks info that lawyers win cases with From: ainsron (ainsron@sbcglobal.net) Thu Nov 4 07:43:04 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Henry Gregor: "Re: VBAC" Previous message: art fougner, md: "Re: Election Results" In reply to: GIN11153@aol.com: "Vacuum extraction in preemies under 34 weeks info that lawyers win cases with" I wouldn't do a VE on a 34 weeker, one reason is because we try to transfer any below 36 weeks to our tertiary care hospital. But for argument sake, I think you are making the prohibition stronger than the literature supports. If you look further at the ACOG practice bulletin, avoidance of VE because of gestational age below 34 weeks is not even listed in the summary section as a level A, B or C recommendation. The term relative contraindication does not mean it should never be done or that it equivalent to malpractice if it is done. If a FHR tracing shows a non-reassuring tracing and an expedited delivery is necessary with a 34 weeker that is complete and at a point where an outlet vacuum or forceps could be performed that it would be better to do a C/S? If a 34 weeker shows evidence of neonatal encephalopathy after VE and also had a antenatal event that placed it at risk, causation should not be attributed solely to the delivery. Prematurity itself is probably the biggest risk factor that applies to this type of infant for developing neonatal encephalopathy and cerebral palsy. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of GIN11153@aol.com Sent: Wednesday, November 03, 2004 6:54 PM To: Multiple recipients of list OB-GYN-L Subject: Vacuum extraction in preemies under 34 weeks info that lawyers win cases with TABLE 3 Relative Contraindications for Vacuum Extraction _____ Fetal prematurity (<34 weeks of gestation) Fetal scalp trauma Unengaged head Incomplete cervical dilatation Active bleeding or suspected fetal coagulation defects Suspected macrosomia Nonvertex presentation or other malpresentation Cephalopelvic disproportion Delivery requiring rotation or excessive traction Inadequate anesthesia _____ Information from references 1, 9, 10 and 12. This is from the AAFP website on vacuum extraction -- ========================== ============ This is from the ACOG Technical Bulletin Operative Vaginal Delivery: Clinical Considerations and Recommendations * What are contraindications to operative vaginal delivery? Under certain circumstances, operative vaginal delivery should be avoided or, at the least, carefully considered in terms of relative maternal and fetal risk. Most authorities consider vacuum extraction inappropriate in pregnancies before 34 weeks of gestation because of the risk of fetal intraventricular hemorrhage {short description of image} <http://www.aafp.org/afp/20000915/spacer.gif> Unfortunately, doctors don't win their malpractice cases when they use a vacuum in a preemie 34 weeks and under. Gail Neuman RNC CPHW SNP LNC listowner of LegalNurseConsulting@yahoogroups.com certified high risk OB/legal consultant Tustin, CA Next message: Henry Gregor: "Re: VBAC" Previous message: art fougner, md: "Re: Election Results" In reply to: GIN11153@aol.com: "Vacuum extraction in preemies under 34 weeks info that lawyers win cases with"

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