BACKGROUND: The vacuum extractor is used in about 5% of deliveries. It is associated with a lower maternal morbidity than is forceps extraction. On the other hand, cephalhematomas, hyperbilirubinemia and cerebral hemorrhages in the baby are observed more frequently. The sudden detachment of the vacuum extractor with appreciable fluctuations in intracranial pressure in the baby is especially dangerous. In order to improve the conventional Malmström system, we have developed a new vacuum extractor and investigated its handling in vitro and in clinical application. PATIENTS AND METHODS: The essential constructional principle of the new vacuum extractor consists in a pivot lowered by ball bearings and a volume reduction of one third. Moreover, in two-chamber vacuum it is possible to give a warning of sudden detachment. The possible tractional force in kiloponds was determined at various angles (0 degree, 15 degrees, 30 degrees und 45 degrees) comparing the Malmström extractor with the new one and two-chamber system in a standardized apparatus. In addition, the new vacuum extractor was also used clinically in 43 women; besides the obstetric parameters, the handling was also appraised. RESULTS: In the in-vitro experiments, a distinct decrease of the possible tractional force with increasing angles was shown for the Malmström extractor (0 degree--15.7 kp, 15 degrees--12.7 kp, 30 degrees--8.6 kp, 45 degrees--7.3 kp). The values for the new one-chamber system were significantly greater from a tractional angle of 15 degrees (0 degree--15.6 kp, 15 degrees--14.4 kp, 30 degrees--14.0 kp, 45 degrees--13.8). The clinical application of the new vacuum system was unproblematic and confirmed the feasibility of good traction. A very much smaller caput succedaneum was found in the baby. Especially in the training situation, the warning system enables a good surveillance before sudden detachment, but reduces the possible tractional force. CONCLUSIONS: The new vacuum system appears to enable the vaginal surgical delivery to be improved compared to the conventional Malmström extractor. After these promising approaches, a multicenter study was commenced in order to enable better evaluation of their clinical significance.

Equipment Design↗

PubMedDate not supplied

[Quality criteria and risks for malpractice in ultrasound prenatal diagnosis. What is allowed--what may be missed?].

BACKGROUND: As with all new diagnostic options in medicine, great hope was placed in the introduction of high-resolution prenatal sonography. Progress tends to carry with it a demanding attitude of higher expectations. Patients and doctors alike may initially overestimate the possibilities of medical advances. QUESTIONS: The question at hand is whether objective criteria can validate a positive influence of prenatal ultrasound on fetal outcome. How should a sonographic routine screening be structured, and what legal aspects need to be taken into consideration? MATERIAL AND METHODS: This is an attempt to survey the heterogeneous pool of internationally published data with regard to these critical questions. Only a rationally devised analysis of possibilities and restrictions of routine prenatal sonography can answer the question of "what--if anything--may be missed?" RESULTS AND CONCLUSIONS: Screening ultrasound matches sonography on indication. Despite controversial data a discussion of different studies leads to a positive conclusion on the benefits of ultrasound monitoring in pregnant women. Ultrasound-screening has an explicit effect on medical and economic issues as well as on litigation.

Congenital Abnormalities↗