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Re: Forces upon forceps application From: Raymond Stephen (Stephen.Raymond@dhhs.tas.gov.au) Sun Nov 23 23:32:42 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Raymond Stephen: "Re: FRI Class B" Previous message: Raymond Stephen: "Re: Forces upon forceps application" In reply to: Dr Eberhard W Lisse: "Re: Forces upon forceps application" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Forces upon forceps application" Cochrane makes it quite clear - more maternal damage with forceps and more fetal damage with vacuum. You should be able to use both, because they are not interchangeable 100% of the time, and the skill of forceps use will have your Caesar rate just that little bit lower. Now, el, a big caveat to this is that there is something about the African pelvis which doesn't lend itself to easy forceps and I really don't know what it is... so maybe your inability to use forceps doesn't matter. Steve -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr Eberhard W Lisse Sent: Sunday, 23 November 2008 11:42 PM To: Multiple recipients of list OB-GYN-L Subject: Re: Forces upon forceps application Baloney? That's a tiny retrospective study looking predominantly at either vacuum or forceps and had only 17 where both was done. And I just found a Cochrane review saying "Use of the vacuum extractor for assisted vaginal delivery when compared to forceps delivery was associated with significantly less maternal trauma (odds ratio 0.41, 95% confidence interval 0.33 to 0.50) and with less general and regional anaesthesia. There were more deliveries with vacuum extraction (odds ratio 1.69, 95% confidence interval 1.31 to 2.19). Fewer caesarean sections were carried out in the vacuum extractor group. However the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages. Serious neonatal injury was uncommon with either instrument." I also note a typo, I meant to write "I was taught" instead of "I was told" "that a failed vacuum means a C/S". Now I am not wishing to start the 53rd Annual Men of Steel Debate ("We Don't Need No Stinking Evidence..."), but saying "Forceps is an Art and Therefor Must be Preserved" is plain nonsense. Especially when those proposing it practice in modern, well equipped and staffed centres where they can do a C/S on very short notice. greetings, el On 23 Nov 2008, at 13:42 , Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote: > I don't have evidence but I was told that a failed vacuum means >>> a C/S and *NEVER* a forceps. > > Baloney the best review on this subject was from Knox Ritichie/ Dan > farine at Mount Siani in Toronto about a decade ago, basically makes > no > difference, but the big qualifier was to be able to go to c-section > quickly. > > -- > Take care, John > -- Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar) el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell) PO Box 8421 \ / Please send DNS/NA-NiC related e-mail Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose. Next message: Raymond Stephen: "Re: FRI Class B" Previous message: Raymond Stephen: "Re: Forces upon forceps application" In reply to: Dr Eberhard W Lisse: "Re: Forces upon forceps application" Next in thread: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Forces upon forceps application"

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