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OB: VE again From: art fougner, md (evsono@pipeline.com) Thu Jan 18 08:45:48 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: observation" Previous message: Robert J Woolley: "Re: observation" this from today's Reuters - Potential adverse neonatal effects of vacuum extraction remain controversial Last Updated: 2001-01-17 8:30:32 EST (Reuters Health) WESTPORT, CT (Reuters Health) - Vacuum extraction increases the risks of cephalhematoma and subarachnoid hemorrhage compared with the use of forceps during delivery, Canadian researchers report in the January 15th issue of the American Journal of Epidemiology. But this result could be an artifact of a study design that masked important links between the indications for the use of vacuum extraction and the adverse outcomes in question, Dr. Pierre Buekens, of the University of North Carolina at Chapel Hill, argues in the same issue of the journal. Dr. Shi Wu Wen of the Bureau of Reproductive and Child Health, Ottawa, Ontario, and a multicenter team examined the risks associated with vacuum extraction versus forceps during vaginal deliveries using observational data collected in Quebec. Through the Med-Echo database, they identified more than 31,000 women who were delivered of live, singleton infants by vacuum extraction and nearly 19,000 who were delivered by forceps between 1991 and 1992 and between 1995 and 1996. While most maternal and infant outcomes the team examined appeared to be unrelated to the use of vacuum extraction versus forceps, three outcomes were significantly associated with this choice. Specifically, vacuum extraction was associated with a lower risk of maternal perineal trauma (risk ratio 0.48), but it was linked to a 5.44-fold higher risk of infant subarachnoid hemorrhage (0.6 cases per 1000 births versus 0.1 cases per 1000 births) and a 2.02-fold increased risk of cephalhematoma (128.2 cases per 1000 births versus 68.2 cases per 1000 births). The authors conclude that the choice of vacuum extraction or forceps during delivery should remain up to the physician, as neither appears to be superior to the other. "The choice of instruments to facilitate vaginal delivery should be based on assessment of the individual woman's health profile," Dr. Wen and colleagues conclude, "and other important medical and nonmedical factors." In his commentary, Dr. Buekens notes that the observational nature of the study, together with some inconsistencies with prior data, raise questions about the validity of the new findings. He suggests that, in the future, case-control or cohort studies could offer a better opportunity to study such rare complications of vacuum extraction without confounding by the underlying indications for the use of this procedure. Am J Epidemiol 2001;153:103-109. -Westport Newsroom 203 319 2700 -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: art fougner, md: "Re: observation" Previous message: Robert J Woolley: "Re: observation"

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