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Re: ventouse - deep transverse arrest/posterior positionFrom: RModugno@aol.comSat Mar 4 14:08:05 2006
In a message dated 3/4/2006 4:54:16 A.M. Eastern Standard Time, Darryl.elrod@LAKENHEATH.AF.MIL writes: Can someone more experienced with vacuum explain how a deep transverse arrest is delivered by a vacuum? I always thought that rotation with the vacuum was contraindicated. If that is the case, how do the babies present at the perineum? The vacuum extractor is a traction device only. Placing the vacuum over the flexion point and applying traction in the axis of the pelvis will allow the levator ani muscle to cause rotation of the fetal head in the transverse or posterior position . One does not and should not make a rotating movement with the vacuum itself. The following table from Dr Vacca's book and the concept of 'fifth's of the head "(zero,being no fetal head palpable above the pelvic brim vs five out of five - being way out of the pelvis, will guide one whether it is safe to attempt vacuum extraction - or forceps for that matter - or proceed directly to cesarean section. It is this concept that was drummed into me at my training program in Durban, South Africa, that I attribute never ( and one usually doesn't say "never" in our business) having a failed forceps or vacuum in my experience. The concept of 'fifths above the pelvic brim " is not taught in American Obstetrics. Selection of patients Station Level Fetal distress Molding Method of delivery Outlet 0/5 Yes or no Slight to severe Vacuum extraction (VEx) Low 0/5 Yes or no Slight to severe VEx (occ. malposition) Mid pelvis 1/5 No Moderate VEx (freq. malposition) Mid pelvis 1/5 Yes Moderate Trial of VEx (or C/S) Mid pelvis 1/5 No Severe Trial of VEx (or C/S) Mid pelvis 1/5 Yes Severe Caesarean section (C/S) Upper pelvis 2/5 Yes or no Slight to severe Caesarean section (C/S) Robert Modugno MD MBA FACOG Marietta, GA
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