Re: Forceps vs. vacuum
From: Andrew Folley (agfolley@hotmail.com)
Sun Dec 4 08:41:53 2005
Unfortuantely we have residents in our program in their 3rd and 4th year who
have already made it clear they will not use forceps for delivery in private
practice and have little if any interest in learing them. They iwill use
the vacuum they say. andy
>From: ainsron@sbcglobal.net (Dr. Ainsworth)
>Reply-To: ob-gyn-l@obgyn.net
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
>Subject: Forceps vs. vacuum
>Date: Sat, 3 Dec 2005 21:17:57 -0600
>
>For you "men of steel," I thought this article in the November Green
>journal made some interesting points:
>
>Forceps Compared With Vacuum
>Rates of Neonatal and Maternal Morbidity
>Aaron B. Caughey, MD, MPP, Per L. Sandberg, MD, Marya G. Zlatnik, MD,
>MMS, Mari-Paule Thiet, MD, Julian T. Parer, MD, PhD and Russell K.
>Laros, Jr, MD
> >From the Department of Obstetrics, Gynecology and Reproductive Sciences,
>University of California, San Francisco; and the Department of
>Obstetrics and Gynecology, California Pacific Medical Center, San
>Francisco, California.
>
>OBJECTIVE: To compare perinatal outcomes between forceps- and
>vacuum-assisted deliveries. Our hypothesis was that the force vectors
>achieved in forceps delivery will lead to fewer shoulder dystocias, but
>greater perineal lacerations.
>
>METHODS: This was a retrospective cohort study of 4,120 term, cephalic,
>singleton, nonrotational operative vaginal deliveries at a single
>institution. Outcomes examined included rates of neonatal trauma,
>shoulder dystocia, and perineal lacerations. Potential confounders,
>including maternal age, birthweight, ethnicity, parity, station at
>delivery, episiotomy, attending physician, anesthesia, and length of
>labor, were controlled for using multivariate logistic regression.
>
>RESULTS: Among the 2,075 (50.4%) forceps- and 2,045 (49.6%)
>vacuum-assisted deliveries, the rate of shoulder dystocia was lower
>among women undergoing forceps delivery (1.5% compared with 3.5%, P <
>.001), as was the rate of cephalohematoma (4.5% compared with 14.8%, P <
>.001), whereas the rate of third- or fourth-degree perineal laceration
>was higher (36.9% compared with 26.8%, P < .001). These differences in
>perinatal complications persisted when controlling for the confounders
>listed above. The adjusted odds ratio for shoulder dystocia was 0.34
>(95% confidence interval [CI] 0.20–0.57), for cephalohematoma was 0.25
>(95% CI 0.19–0.33), and for third- or fourth-degree lacerations was 1.79
>(95% CI 1.52–2.10) when comparing forceps to vacuum.
>
>CONCLUSION: Vacuum-assisted vaginal birth is more often associated with
>shoulder dystocia and cephalohematoma. Forceps delivery is more often
>associated with third- and fourth-degree perineal lacerations. These
>differences in complications rates should be considered among other
>factors when determining the optimal mode of delivery.
>
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