Re: OA vs. OP
From: Myer S. Bornstein, MD, MMM, CPE, FACOG (mborn@massmed.org)
Sun Dec 31 09:14:16 2000
Danny
did the patient complain of a "spinal type headache" post delivery. We had
a case with severe post spinal HA in a patient with an epidural that had a
middle cerebral thrombosis. In This type of Headache not responding to
even a blood patch, it was recommended a CAT Scan.
--
Myer S. Bornstein, MD, MMM, CPE, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Danny
Tucker
Sent: Sunday, December 31, 2000 10:57 AM
To: Multiple recipients of list OB-GYN-L
Subject: OB: 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
