A review of 2000 consecutive forceps deliveries

Two thousand forceps deliveries done at the Philippine General Hospital from October 1945 - January 1951 were reviewed. The indications, conditions, and contra-indications for forceps operations were analyzedA total of 1,404 low forceps (70.2%), 569 midforceps (28.4%) and 27 high forceps (0.1%) were noted. Indicated forceps occurred in 995 cases (49.8%) and non-indicated forceps in 1,005 cases (50.2%). Maternal indications (948 cases) were the most frequent causes for the operation while fetal indications (47%) were rare causesLess complications were noted in low operations than in the higher types of operations. The most serious complications were rupture of the uterus, deep perineal tears, and cervical tears. Morbidity was found related with the type of operation. Fifteen maternal deaths caused by midforceps in eight cases and by low forceps in 7 cases were observed. Uncorrected maternal mortality was 0.75% while corrected mortality was 0.1%Two forceps operations were presented with poor results. Adequate prenatal and natal care were deemed neededThe study indicated that high forceps should be condemned and that midforceps be avoided

Sixty-two consecutive cases of symphyseotomy

The following advantages of symphyseotomy are very evident: 1. It can prevent craniotomy on the living child in failed forceps extraction, when delivery through the abdominal route offer greater hazards to the mother2. With proper skill, the dangers attending the mother in symphyseotomy can be minimal3. It is done in quick time and in a very simple way and therefore would contribute the least shock to a patient subjected to a very long test of labor4. There is no invasion of the abdominal cavity, no exposure of the abdominal viscera, no spill into the abdominal cavity of infected uterine seepage5. Postoperative courses, despite the very bad nature of the cases, are often smooth6. There is no scar which will serve as a point of weakness in the uterine wall and therefore there is no fear of rupture in the succeeding pregnancies and labor7. There is improvement in the capacity of the pelvis, thus enabling the patient to meet future requirements towards more natural delivey. (Conclusion)

Anesthesia in obstetrics

In good hands, the administration of drugs to alleviate pain during labor brings many benefits with negligible risks. Adequate facilities and well trained personnel, however, are necessary to obtain the desired results. It calls for quick detection of complications; and it places added responsibility to the obstetrician, due to the increased hazards to both mother and child. (Summary)