Dec. 3, 1999
Benedetti authors editorial on birth injury
Thomas Benedetti, professor of obstetrics and gynecology and director of maternal-fetal medicine at UW Medical Center, is the author of an editorial on birth injury and method of delivery in the Dec. 2 issue of the New England Journal of Medicine.
In his commentary, Benedetti examined the May 1998 public health advisory from the Food and Drug Administration (FDA) on the use of vacuum-assisted delivery devices and the response to the advisory by the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice.
Citing risk of intracranial injury, the FDA public health advisory admonished practitioners to use vacuum delivery devices only when a specific obstetric indication was present. ACOG expressed concern that this dissuasion might increase the rates of Cesarean delivery and forceps use.
Benedetti interpreted the opinions of both groups in the context of data reported by Dena Towner of the University of California at Davis. The Towner study showed that the risks of injury to the baby were the same for successful vaginal delivery with either forceps or vacuum and for Cesarean section after labor had begun. This suggested that the baby's risk for injury was related to labor rather than the method of delivery when vaginal delivery was successful.
Benedetti pointed out that if attempts at operative vaginal delivery fail, the infant is more likely to be injured, compared to infants who didn't have a failed attempt at delivery.
He said it is incumbent on the clinician to gather all available patient data to determine if successful vaginal delivery can be accomplished with the chosen instrument. He discouraged clinicians from trying operative delivery when the chances of success appear to be low, or from repeated attempts to deliver vaginally once vacuum extraction or forceps fail.
All rights reserved.