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Re: Forceps vs. vacuum From: ainsron (ainsron@sbcglobal.net) Sun Dec 4 13:01:39 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Efrain Ramirez: "Re: 41 week Induction" Previous message: DoctorJoe@aol.com: "Re: FRI Vag delivery, c-section, and the pelvic floor" In reply to: Peter Wein: "Re: Forceps vs. vacuum" Next in thread: Andrew Folley: "Re: Forceps vs. vacuum" I like the Kiwi cup, very simple use and it is nice to have complete control of the establishment/maintenance of the vacuum pressure. The one issue I have with it is the diameter and length of the vacuum line. Sometimes it fills up with fluid and then you simply lose the pressure and can't repressurize the cup. The length is the other issue, I have to lower the table 3-4 inches below where I usually have it, otherwise, mechanically it is not comfortable to use. When I am expecting a "difficult" vacuum, whatever that is, I still prefer the mityvac. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Peter Wein Sent: Saturday, December 03, 2005 9:49 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Forceps vs. vacuum The rates of 3rd and 4th degree tear seems extraordinarily high. We discussed this article in our jounral club - Aldo Vacca, who invented the Kiwi Omnicup was there. It is a study over a very long period, using lots of operators, with old-fashioned cups. We were surprised it slipped past the editors. Peter Dr. Ainsworth wrote: >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. > Next message: Efrain Ramirez: "Re: 41 week Induction" Previous message: DoctorJoe@aol.com: "Re: FRI Vag delivery, c-section, and the pelvic floor" In reply to: Peter Wein: "Re: Forceps vs. vacuum" Next in thread: Andrew Folley: "Re: Forceps vs. vacuum"

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