[About the choice of extraction instrument for vaginal operative termination in vertex presentation (author's transl)]

Abstract

The common separation of indications at the First University Clinic for Obstetrics and Gynecology in Vienna concerning the choice of extraction instrument in cases of operative termination of vaginal delivery out of vertex position is being demonstrated. When there is only a slight increase of resistance in the delivery mechanism, when the child is mature, when there is no attitude of deflexion, and where there is no real reason for a speedy termination of delivery, the vacuum extractor comes into use. In cases of child emergency, of considerable increase of delivery mechanism resistance, of immaturity and attitude of deflexion, an extraction by means of obstetrical forceps is performed. Out of 547 deliveries terminated by means of extraction the sub- and postpartal mortality amounted to 2,19%. The number of prematures (7,5%) in this material did not differ from the total delivery material of the clinic. After forceps extraction 5 out of 419 children (2,8%) died. After vacuum extraction one child out of 105 (0,95%) died. In 23 cases where obstetrical forceps had to be used after vacuum extraction 2 children died (8,7%). The morbidity of the children was measured by means of the Apgar Score and of the injury frequency. Here the two extraction methods showed no significant differencies. The combined application of both extraction instruments however, showed an increase of morbidity. Injuries of the mother were almost exclusively found after forceps extraction.