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Re: vacuum extraction criteriaFrom: croure@ibm.netFri Mar 10 16:39:12 2000
At Fri, 10 Mar 2000, ainsron@msn.com wrote: > >I was trained in my residency to use both forceps and vacuum and feel >comfortable using either. I must say that over the years, I have >gravitated towards using Vacuum over forceps because of its simplicity >and ease of use, spontaneous rotation of a posterior presentation, ease >of application with minimal anesthesia, etc., especially with the new >silastic cups, as opposed to the rigid metal cups I trained with. > >I am certainly aware of the risks and have a written handout discussing >both forceps and vacuum that is given to my patients. Additionally, I >discuss with the labor patient and her family why I am recommending >delivery with vacuum or forceps, including the "marks" they leave on the >babies and the small risk of long term damage and give them the >alternative of C/S while encouraging them that the procedure I am >recommending is generally safe and will be abandoned if it doesn't >progress normally. You have to admit that the risk of major >injury/death is quite small, the FDA report of 12 deaths and 9 serious >injuries (5/year) in the period in question vs. a denominator of total >vacuum assisted births (228,354 in 1995) comes out to ~1:45,000. > >I am also acutely aware that even in the best of hands, there are no >guarantees. A well-trained colleague of mine delivered the grandchild >of another physician in our community, using the vacuum extractor and >the baby suffered major neurologic consequences. The case is currently >in litigation and was the focus of the 20/20 report in January 1999. > > You seem to have a very solid approach and well informed approach. Recently the NEJM published a report where in this cirumstances vacuum extraction and forceps application if successful are all equal with C/S in fetal morbidity. (Not so if unsuccessful and then a C/S is required. I am just curious if any and how many (grossly) of the patients in your hospital would choose a C/S over forceps deliveries and or vacuum extraction. Reason I ask is that in Puerto Rico the popular opinion on forceps is so bad that merely mentioning the word will make most tremble. Not all will refuse it but the majority would. Carlos and
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