Re: OB: Ritgen's Avoidance
From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com)
Mon Jul 29 17:23:35 2002
Hmmm, and again anecdotal, but I like this maneuver, and feel it decrease
the risk for tears (and length of terminal bradycardias) by adjusting the
vector of the out-coming head. Enhances and quickens extension. I could be
wrong, though: I could be Art.
--
Richard Chudacoff, MD, FACOG
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Anna
Meenan, MD
Sent: Monday, July 29, 2002 5:13 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: OB: Ritgen's Avoidance
Sounds good, but it is SO hard to get a resident to keep his/her hands
off the perineum. Plus we have an older OB on the unit who swears by
Ritgen and makes a big show of insisting the residents all use it.
Anna Meenan, MD
At Mon, 29 Jul 2002, art fougner, md wrote:
>
>This in today's ReutersHealth - pity Woolley isn't around to comment.
>
>Avoiding manual pressure on perineum reduces risk of episiotomy after
>childbirth
>
>Last Updated: 2002-07-26 9:35:48 -0400 (Reuters Health)
>
>NEW YORK (Reuters Health) - An innovative "hands-poised" method of
>childbirth during vaginal delivery reduces the risk of perineal trauma
>and the need for episiotomy compared with the traditional "hands-on"
>approach, Austrian investigators report.
>
>More than 1000 women with an uncomplicated pregnancy in cephalic
>presentation were randomly assigned to one of the two delivery methods.
>Dr. Klaus Mayerhofer, of the University of Vienna Medical School, and
>associates discuss their findings in The Journal of Reproductive
>Medicine for June.
>
>In the Ritgen hands-on method, first reported in 1828, "the left hand of
>the midwife puts pressure on the infant's head, and the right hand is
>placed against the perineum." This is done as a means of supporting the
>perineum and to provide lateral flexion to ease delivery of the infant's
>shoulders.
>
>The new method, described in 1998, involves the clinician keeping his or
>her hands poised to apply light pressure to the infant's head if
>necessary, but the perineum is not touched.
>
>In their prospective study, Dr. Mayerhofer observed a similar incidence
>of perineal tears in the two groups. However, the hands-on method
>resulted in third-degree perineal tears in 2.7% of patients, versus 0.9%
>of those receiving hands-poised care (p=0.035). Episiotomy was required
>in 17.9% and 10.1% of patients, respectively (p=0.001).
>
>The researchers suggest that tension during delivery causes the perineum
>to become thinner and more vulnerable. "Additional pressure applied by
>the midwife may result in ischemia in the perineal tissue and facilitate
>severe perineal injury," they surmise.
>
>The Austrian team concludes that the hands-poised method is a safe and
>effective birthing alternative.
>
>J Reprod Med 2002;47:477-482.
>
>art
>
>--
>art fougner, md
>ich bin ein New Yorker
>
