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Re: vacuum extraction criteriaFrom: croure@ibm.netFri Mar 10 04:57:13 2000
At Thu, 09 Mar 00, steve wrote: > . It was not my intention to be personal. Apology accepted. I did say >that the question was silly, not the questioner. Apology cancelled:) :) joke, apology accepted. > >I guessed as much, but not being taught something as a resident >is not a good reason for not using the procedure. I wasn't taught >colposcopy or hysteroscopy, but I have learnt them since because >they are necessary parts of my management. Agree, me too. I wasn't taught either but have been able to learn them without fearing that I am placing a patient in danger.
Another thread that
>is going on at present concerns sacrocolpopexy - I'll bet you It is so simple that it is silly. Perhaps it wasn't expressed too well, or perhaps it was expressed toooo well. Perhaps it wasn't so much a medical question but a philosphical question which are always much harder. Since, in spite of all the flames I still am interested in the topic, I will try to express it better in my secondary language---english. At my hospital vacuums extractions are done, very infrequently but they are done. I have looked at them to see if it is something that I want to learn and frankly it looks to me sort of horrendous. Not that forceps is any better nor a difficult cesarean section. But anyway, the FDA published the following: In May 1998, the Food and Drug Administration (FDA) issued a public health advisory to all practitioners who deliver babies. The advisory, entitled "Need for Caution When Using Vacuum Assisted Delivery Devices," (1) was based on reports to the FDA of 12 deaths and 9 serious injuries during vacuum deliveries in the preceding four years. In the 12 years before that period, much smaller numbers of such complications had been reported. The advisory noted the most serious complications of vacuum delivery -- subgaleal hematoma and intracranial hemorrhage -- and emphasized that vacuum devices should be used only for specific obstetrical indications. We must all agree that it is good to know how to apply well forceps and I imagine it must be good to also know how to apply well vacuum extractor for there will be instances when that will be your best option. Now finally I am getting close to my original question, which is, if you *only* use vacuums or even forceps in very selected instances, you will be doing so few that how do you learn how to use it or, after you became an *expert* in your residency, how do you maintain your expertise afterward with so little usage? That simple and silly question is it. Now, that was coupled with another angle which probably turned people off even more that the silly question. And that is that I think that many more vacuums and even forceps are used than "really" needed because so much epidurals are being used. Paul reported 80% epidurals at his hospital. And then as posted originally somebody has a terminal fetal distress in a patient with epidural and can not push the baby out. So we have sort of a an emergency that needs to be solved by the best method that the physician decides, but which are all terrible no matter which study you look into, and worse of all, this solution is a solution to a problem partially caused by us. ie, the epidural Do my patients use epidurals? Yes!!!!!! Frequently? Obviously not. I give them real informed consent which the anesthesiologists at my hospital hate (less income) and most get turned off and labor very well.. Philosophically, I have grown into the idea that we physicians have instrumentalized, medicalized and messed with labor too much. Obviously I am talking about normal pregnancy and labor, not about they myriad of medical and obstetrical problems that do ensue, and truly they are many. This is too long, for whatever it's worth, I hope it is clear, courteous and not too low for the level of the listmembers.
Carlos
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