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The forceps and the vacuum extractor
The forceps and the vacuum extractor Editorial
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T H E F 0 L L 0 W I N G two articles, one from the United States and one from Israel, attempt to resolve the controversy between the advocates of the classical forceps and those of the Malmstrijm vacuum extractor. These two articles were by chance received in the editorial office within twenty-four hours of each other. In an effort to make the basis of the two studies readily comparable to the readers of the JOURNAL, the Editors suggested that at least two tables of the articles be identical in structure. To this request both groups of authors have courteously consented. As a result direct comparison is possible between the “Basic Characteristics of the Clinical Material” which appear as Table I in both articles and also between the “Perinatal Complications” which are presented as Table IX in the article by Steer and his associates and as Table VIII in the article by Schenker and Serr. The publication of these two articles, on the relative usefulness and safety of the two devices, will unfortunately leave many questions unsettled. The article from Israel compares two different periods, one in which forceps was the instrument of choice and one in which the extractor was used by preference. The frequency of delivery by the two methods was relatively the same, namely, 3.9 and 5.7 per cent. In the series from Israel both instruments were frequently applied with “the head above the spines.”
The perinatal results were about the same for the two instruments. The article from the United States is based on 201 vacuum extractions, performed during the years 1961-1965, during a period when 5,545 forceps operations were carried out. The clinical problems which were faced with the use of the two instruments seem to have been similar, at least to the extent that the head was “below the spines” in practically every case for each instrument. However, the ratio of 201 vacuum extractions to 5,545 forceps operations suggeststhat the former procedure may have been called upon under special circumstances and certainly that it was carried out by operators with a smaller experience with this particular procedure. The tendency to a lower Apgar score following extraction may perhaps be attributable to these differences and not to the instrument. The occurrence of cephalhematoma is of course a characteristic side effect of the vacuum extractor. This editorial was written largely to indicate the need for suspended judgment in America with respect to the vacuum extractor, which has received widespread approval in Europe. It is further to comment on the extraordinary difficulty involved in the setting up of clinical trials that will fairly test two procedures, each of which can be counted on to yield a high percentage of successfulresults.
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T H E F 0 L L 0 W I N G two articles, one from the United States and one from Israel, attempt to resolve the controversy between the advocates of the classical forceps and those of the Malmstrijm vacuum extractor. These two articles were by chance received in the editorial office within twenty-four hours of each other. In an effort to make the basis of the two studies readily comparable to the readers of the JOURNAL, the Editors suggested that at least two tables of the articles be identical in structure. To this request both groups of authors have courteously consented. As a result direct comparison is possible between the “Basic Characteristics of the Clinical Material” which appear as Table I in both articles and also between the “Perinatal Complications” which are presented as Table IX in the article by Steer and his associates and as Table VIII in the article by Schenker and Serr. The publication of these two articles, on the relative usefulness and safety of the two devices, will unfortunately leave many questions unsettled. The article from Israel compares two different periods, one in which forceps was the instrument of choice and one in which the extractor was used by preference. The frequency of delivery by the two methods was relatively the same, namely, 3.9 and 5.7 per cent. In the series from Israel both instruments were frequently applied with “the head above the spines.”
The perinatal results were about the same for the two instruments. The article from the United States is based on 201 vacuum extractions, performed during the years 1961-1965, during a period when 5,545 forceps operations were carried out. The clinical problems which were faced with the use of the two instruments seem to have been similar, at least to the extent that the head was “below the spines” in practically every case for each instrument. However, the ratio of 201 vacuum extractions to 5,545 forceps operations suggeststhat the former procedure may have been called upon under special circumstances and certainly that it was carried out by operators with a smaller experience with this particular procedure. The tendency to a lower Apgar score following extraction may perhaps be attributable to these differences and not to the instrument. The occurrence of cephalhematoma is of course a characteristic side effect of the vacuum extractor. This editorial was written largely to indicate the need for suspended judgment in America with respect to the vacuum extractor, which has received widespread approval in Europe. It is further to comment on the extraordinary difficulty involved in the setting up of clinical trials that will fairly test two procedures, each of which can be counted on to yield a high percentage of successfulresults.
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