Re: Forces upon forceps application
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Sun Nov 23 08:15:25 2008
Great discussion. El, the fact that you don't do forceps limits your
practice in a few cases. If the only tool you have is a hammer, then
everything is a nail.
That gist of ACOGs quote was certainly in my mind, and I really debated
whether to start with the vacuum versus forceps. My instinct was
forceps but I chose the vacuum to make it more palable for the couple,
which was probably silly. I hope that you guys won't think this
hogwash, but it was obvious that she would deliver vaginally (ROA, +3,
head visible with the labia parted, little caput, small baby, normal
labor progress) and I was surprised that I didn't achieve station with
the first pull.
As John alluded, there likely is some selection bias in studies, as many
of us who use both forceps and vacuums would select easier cases for
vacuums, and harder ones for forceps; I know that I do, i.e. if I think
that a vacuum will work, I use it over forceps (due to less maternal
trauma; thanks, El). That is certainly a change from my training.
Garry
At Sun, 23 Nov 2008, R. Daniel Braun wrote:
>
>>From ACOG Practice Bulletin 17 2000 Reaffirmed 2008
>
> - *Is there a role for the use of alternative instruments after a failed
> attempt?*
>
> Persistent efforts to obtain a vaginal delivery using different instruments
>may increase the potential for maternal and fetal injury and often indicates
>cephalopelvic disproportion. Although studies are limited, the weight of
>available evidence appears to be against attempting multiple efforts at
>operative vaginal delivery with different instruments, unless there is a
>compelling and justifiable reason (28). The California study reported that
>the incidence of intracranial hemorrhage was highest in infants delivered by
>combined vacuum and forceps compared with other reported methods of delivery
>(21). The incidences of other injuries also were increased with combined
>methods of operative vaginal delivery.
>
>Dan
>
>On Sat, Nov 22, 2008 at 6:05 PM, Garry E. Siegel, M.D. <
>garrys@mindspring.com> wrote:
>
>> El:
>>
>> You're right, and I was very cautious and thought about the situation
>> before proceeding.
>>
>> She was ROA +3 and I felt it would deliver vaginally. I was quite
>> surprised when I did not achieve any station with the first vacuum pull.
>> I then switched and it was relatively easy. Perhaps my vector was wrong
>> on the vacuum, or my application not as good as it should have been.
>>
>> Garry
>>
>> At Sat, 22 Nov 2008, Dr Eberhard W Lisse wrote:
>> >
>> >Forceps after failed Vacuum (for a high head)?
>> >
>> >Dr Cochrane will not be helping...
>> >
>> >el
>> >
>> >On 22 Nov 2008, at 18:58 , Garry E. Siegel, M.D. wrote:
>> >
>> >> Dr. Simpson and Luikhart (combined effort) helped me yesterday AM
>> >> after
>> >> a vacuum didn't achieve any station with a pull.
>> >>
>> >> My instinct was to start with the forceps but the patient put a bit of
>> >> pressure on me to try the Omni Cup first.
>> >>
>> >> As one of my mentors said, if he had to practice Ob on a desert island
>> >> with only one set of forceps, it would be a set of Kiellands!
>> >>
>> >> Garry
>> >>
>> >> At Fri, 21 Nov 2008, Andrew Folley wrote:
>> >>>
>> >>> Welcome to the "dying art of forceps delivery". Residents today
>> >>> bluntly state they will never use forceps on a woman.
>> >>> In one more generation forceps will be relegated to the
>> >>> hospital museum in the basement. Personally I can not
>> >>> imagine practicing OB without having comfort in forceps use
>> >>> and vagian breech delivery. andy
>>
>> --
>> Garry E. Siegel, M.D.
>> Private Practice
>> Roswell, GA
>>
>--
>R. Daniel Braun, MD FACOG(L) ABMP CMTh
>Professor Emeritus
>Dept. of Obstetrics and Gynecology
>Indiana U. School of Medicine
>
>R. Daniel Braun
>
> "Science without Religion is LAME; Religion without Science is BLIND"
> Einstein 1941
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
