-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Vacuum vs. forceps From: Ashley Hill (dahmd@gate.net) Sat Oct 4 00:08:36 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bernard Cristalli: "Re: IUPC and VBAC" Previous message: Roberta Speyer: "Is There A Doctor In The House???" Maybe in reply to: rbraun@indyunix.iupui.edu: "Vacuum vs. forceps" Next in thread: douglas krell: "Re: Vacuum vs. forceps" R.Daniel Braun, MD FACOG wrote: > I seem to have missed something here. Where are these studies ? > The last time I checked the literature was equally divided and said they > were of equal efficacy. I use both vacuum and forceps. My understanding of the literature is that while forceps and vacuum appear equal with regards to actual delivery (getting the baby out), as you suggest, forceps clearly cause more maternal perineal trauma. Whether this is from operator experience or issues inherent with forceps is unclear to me, but many of my patients are dead set against forceps, and will ask for the vacuum by name. Apparently they are reading or hearing about this issue (maybe they subscribe to Ob-gyn-l) and are concerned about rectal trauma. Below are a few of the articles discussing forceps vs. vacuum. Someone with your experience may be able to overcome the apparent problems with forceps and rectal trauma, but as forceps training diminishes (at least in the U.S.) I'll bet that such trauma actually increases over the next 10 years. Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL A randomised prospective study comparing the new vacuum extractor policy with forceps delivery. (Br J Obstet Gynaecol, 100(6):524-30 1993 Jun). Of the vacuum extractor group, 85% were delivered by the allocated instrument compared to 90% in the forceps group. There were significantly fewer women with anal sphincter damage or upper vaginal extensions in the vacuum extractor group(11% vs 17%, OR 0.6; 95% CI, 0.38-0.97). CONCLUSIONS: Assisted vaginal delivery using the new vacuum extractor policy is associated with significantly less maternal trauma than with forceps. Anal sphincter trauma during instrumental delivery. Sultan AH; Kamm MA; Bartram CI; Hudson CN. (Int J Gynaecol Obstet, 43(3):263-70 1993 Dec). Anal endosonography, manometry, pudendal nerve terminal motor latency (PNTML) measurements and perineometry were performed in 43 primiparae who had an instrumental delivery (17 vacuum and 26 forceps) and in 47 who had a normal vaginal delivery (controls). RESULTS: Defecatory symptoms developed in 10 (38%) women following a forceps delivery compared with 2 (4%) in the control group (P = 0.0003), and 2 (12%) following a vacuum extraction (P = NS). Anal sphincter defects occurred in 21 (81%) forceps deliveries compared with 17 (36%) controls (P 0.0005) and 4 (21%) vacuum extractions (P = NS). CONCLUSIONS: Compared with vacuum extraction, forceps delivery is associated with significantly more damage to the anal sphincters and hence an increased incidence of defecatory symptoms. A randomized prospective trial of the obstetric forceps versus the M-cup vacuum extractor. Bofill JA; Rust OA; Schorr SJ; Brown RC; Martin RW; Martin JN Jr; Morrison JC. (Am J Obstet Gynecol, 175(5):1325-30 1996 Nov). CONCLUSIONS: The M-cup vacuum extractor cup appears to be as efficient (and faster) than the obstetric forceps but is associated with significantly more fetal cephalhematomas, whereas maternal injuries are more common with the forceps. Next message: Bernard Cristalli: "Re: IUPC and VBAC" Previous message: Roberta Speyer: "Is There A Doctor In The House???" Maybe in reply to: rbraun@indyunix.iupui.edu: "Vacuum vs. forceps" Next in thread: douglas krell: "Re: Vacuum vs. forceps"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Dec 2 05:21:38 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.