Surgical Techniques
Anatomy for the laparoscopic surgeon
Laparoscopic surgery is a safe and effective option for many patients, provided the surgeon knows the relevant anatomic landmarks and variations...
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“UPDATE ON OPERATIVE VAGINAL DELIVERY”
ERROL R. NORWITZ, MD, PhD (JUNE 2014)
Believes outlet forceps delivery is sometimes justified
While I found the article “Update on operative vaginal delivery” by Dr. Errol Norwitz very informative, I would like to inject what I hope is a little common sense into the warning to only attempt operative delivery with either forceps or vacuum, never both.
My objection to this rule is that it ignores those situations where the vacuum is used for a vertex slightly above the perineum, when the head descends easily to the introitus, but, because of caput and molding, cannot be delivered because adequate vacuum cannot be maintained. I believe an outlet forceps delivery in this situation is more justified than a trip to the OR for cesarean delivery. An outlet forceps delivery can resolve the concern about the infant’s health faster than would a cesarean delivery.
E. Darryl Barnes, MD
Richmond, Virginia
Dr. Norwitz responds:
I’d like to thank Dr. Barnes for his interest and his comments. The decision to perform a forceps delivery after a failed vacuum extraction should be taken with extreme caution. The literature is clear that such deliveries are associated with a high risk of birth injury. While it is true that, in select cases, such an approach may expedite delivery sooner than an emergency cesarean and, as such, could be seen as a reasonable option under the circumstances, this decision may prove difficult to defend should a birth injury result. Might I suggest that providers reach first for the forceps.
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