Grand Rounds: Protecting the perineum during operative vaginal delivery

Article

Unless operative vaginal delivery can be made at least as safe as cesarean delivery, it will be difficult to justify its continued existence. Proper technique is paramount.

Key Points

Free CME Online

ACCREDITATION
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of CME2, Inc. ("cme2 ") and Contemporary OB/GYN. cme2 is accredited by the ACCME to provide continuing medical education for physicians.

cme2 designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

EDUCATIONAL OBJECTIVES
After completing the following CME activity, the reader should be able to:

TO EARN CREDIT FOR THIS ACTIVITY
Participants should study the article and log onto http:// http://www.contemporaryobgyn.net/, where they must pass a post-test and complete an online evaluation of the CME activity. After passing the post-test and completing the online evaluation, a CME certificate will be e-mailed to them. The release date for this activity is May 1, 2007. The expiration date is May 1, 2008.

DISCLOSURES
Editors Elizabeth A. Nissen and Paul L. Cerrato disclose that they do not have any financial relationships with any manufacturer in this area of medicine.

The manuscript reviewer discloses that he is a retained consultant for Adeza Biomedical.

Dr. Hirsch discloses that he has no financial relationships with any manufacturer in this area of medicine.

RESOLUTION OF CONFLICT OF INTEREST
cme2 has implemented a process to resolve conflicts of interest for each continuing medical education activity, to help ensure content objectivity, independence, fair balance, and that the content is aligned with the interest of the public. Conflicts, if any, are resolved through a peer review process.

UNAPPROVED/OFF-LABEL USE DISCUSSION
Faculty may discuss information about pharmaceutical agents, devices, or diagnostic products that are outside of FDA-approved labeling. This information is intended solely for CME and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information. Faculty are required to disclose any off-label discussion.

Operative vaginal delivery-which includes vaginal birth with the assistance of either forceps or vacuum devices-is one of the few remaining areas in obstetrics that may still be called an "art." But how long can it survive in an era of concerns about integrity of maternal tissues and short-and long-term maternal and fetal outcomes-a climate in which legal liability has contributed to ever-diminishing vaginal birth rates? Such concerns are amplified for operative (vs. nonoperative) vaginal delivery and threaten to eliminate the procedure from the armamentarium of newly trained obstetricians.

Compare trainees' experience with operative vaginal delivery to cesarean delivery. The Accreditation Council for Graduate Medical Education (ACGME) reports that in academic year 2005/2006, the national median for cesarean delivery cases per senior resident graduate over 4 years (either as primary operator or assistant) was 243 (ACGME Summary Report: Obstetrics; Residency Review Committee for Obstetrics and Gynecology, 2006). In contrast, the median 4-year experience for forceps was 11 cases and for vacuum extraction, 21. Most practitioners would agree that these numbers represent an inadequate level of training in operative vaginal delivery.

Recent Videos
Mirvie's RNA platform revolutionizes detection of fetal growth restriction | Image Credit: wexnermedical.osu.edu
How early genetic testing empowers parents and improves outcomes | Image Credit: tuftsmedicine.org
Dallas Reed highlights trends and barriers in prenatal genetic testing | Image Credit: tuftsmedicine.org
How maternal fetal medicine specialists improve outcomes for high-risk pregnancies | Image Credit: profiles.mountsinai.org
How the cobas liat assay panels improve STI detection | Image Credit: labqualityconfab.
Screening-to-diagnosis interval vital for gestational diabetes outcomes | Image Credit: ultracon2024.eventscribe.net
Henri M. Rosenberg, MD
Medical experts personalize contraceptive options for complex cases | Image Credit: findcare.ahn.org
Study explores the limits of neighborhood data in predicting preterm birth | Image Credit: linkedin.com
Barbed suture reduces blood loss in hysterectomy | Image Credit: linkedin.com
Related Content
© 2025 MJH Life Sciences

All rights reserved.