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OB: OA vs. OP From: Danny Tucker (danny@womens-health.co.uk) Sun Dec 31 08:54:30 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP" Previous message: Eberhard W Lisse: "Re: Multiracial babies - was: poop hits the fan" Next in thread: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP" Reply: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP" Interesting discussion, and a very pertinent one for the UK, where the number of obstetricians trained in rotational forceps is dwindling rapidly. Many of the newer trainees haven't even seen them, and most of the Consultants who were trained haven't touched them in years. The latter group are the most dangerous in my experience, as they may be tempted to get them out of storage once every couple of years. >From a practical point of view, I am increasingly confident with the OP cup ventouse, and where the 'flexion' point can be reached and the station low, I tend to use this to reduce the need for episiotomy. If the fetal head is particularly deflexed, and/or caput significant, the Kielland's are very useful. Those who use them will appreciate that very satisfying sensation pushing the handles just that little bit further posteriorly and feeling the baby rotate with a gentle turn of the fingers. I came across an interesting case a few months ago, and would be interested to hear if anyone else has experienced this. Primigravida, normal pregnancy & first stage, average sized baby, no fetal distress, but arrest of progress in active 2nd stage. Head well down on abdominal palpation, very deflexed OP at station +1 to +2. A bit unhappy as the deflexion was so much that it approached brow. Poor analgesia, so transferred to theatre for epidural top-up, proper assessment & delivery. Definitely a brow presentation, but station low at +2. On vaginal examination it certainly felt like there was plenty of room & could even flex the head a bit. Rotation with Kielland's was fine, but Neville Barnes used for traction, following manual flexion of the head. No extension of episiotomy & baby fine. Tragically, the mother died on day 2 of a massive idiopathic intracranial thrombosis. I have never seen the Kielland's used for a brow, but I have never come across a brow presentation that is so low. Danny. -- Danny Tucker MRCOG Sheffield, UK http://www.womens-health.co.uk Next message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP" Previous message: Eberhard W Lisse: "Re: Multiracial babies - was: poop hits the fan" Next in thread: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP" Reply: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: OA vs. OP"

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