Commentary

Vacuum followed by forceps questioned


 

I greatly appreciated “Vacuum extraction: optimizing outcomes, reducing legal risk” [April] by Karen Koscica, DO, and Martin Gimovsky, MD. While they described a “contraindication” to vacuum delivery as “prior failed forceps,” they later stated, “If vacuum delivery is abandoned, do not switch to forceps unless the physician has extensive experience utilizing both instruments.”

As far as I know, the current published literature on sequential operative vaginal delivery does not differentiate between forceps followed by vacuum or vacuum followed by forceps. If such literature exists supporting the contention that vacuum followed by forceps carries equal risk to vacuum alone, I would be most interested in the citation. Again, thank you for an excellent article on vacuum delivery.

Russel Jelsema, MD
Grand Rapids, Mich

DRS. Koscica and gimovsky respond:

We thank Dr. Jelsema for his interest in our article. We do agree with his statement that the current literature on sequential operative vaginal delivery does not differentiate between vacuum followed by forceps or forceps followed by vacuum. However, in a trial of instrumental delivery with either vacuum or forceps, the most important rule to follow is immediate descent of the fetal head with the initial traction effort. If this is not achieved, consider the cause of failure to be either true disproportion, improper instrument placement, or traction technique.

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