Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

OBJECTIVE: To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). METHODS: 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. RESULTS: It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. CONCLUSION: KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps.

Forceps and vacuum delivery: expectations of residency and fellowship training program directors.

The objective of this study is to compare current forceps training practices in North American obstetrical residency training programs with that in maternal-fetal medicine fellowship programs. We sent a survey to all obstetrics and gynecology residency training programs and to all maternal-fetal medicine fellowship programs in North America. After sending out 354 questionnaires, 219 were returned for a response rate of 62%. The response rate for fellowship programs (52 of 59; 88%) was significantly greater than that of residency training programs (167 of 295; 56.6%) (p < 0.05). All fellowship training programs were using the 1988 ACOG forceps classification system, as were 98% of the residency training programs. Eighty-five percent of fellowship directors and 80% of residency directors felt the same system should be used for vacuum deliveries. All residency and fellowship directors expected proficiency with both instruments for outlet deliveries. For low deliveries requiring < or =45 degrees of rotation, at least 92% expected proficiency with both instruments. For low-forceps deliveries with >45 degrees of rotation, 82% of fellowship directors and 80% of residency directors expected proficiency. For low-vacuum deliveries with >45 degrees of rotation, 80% of fellowship directors and 76% of residency directors expected proficiency. Significantly more fellowship directors expected midforceps proficiency (47%) than did residency program directors (38%) (p < 0.05). Midvacuum proficiency was expected by 73% of fellowship directors and 69% of residency directors. The ACOG 1988 forceps classification system has now achieved wide acceptance and is taught by both residency and fellowship program directors. Most program directors favor using the same classification system for vacuum extraction deliveries. In general, the expectations of the residency program directors mirror those of maternal-fetal medicine fellowship directors. While outlet and low operations with < or =45 degrees of rotation are taught and proficiency is expected, most programs no longer expect proficiency in midforceps delivery, but do expect proficiency in midvacuum delivery. Proficiency in low operations with rotations < or =45 degrees is still expected.

[Presentation of the Salas obstetrical forceps (Forceps Salas)]. / Presentación de las espátulas obstétricas de Salas (Fórceps Salas).

In the magazine of Gineco Obstetricia de México, January 1988, 30 to 34, I presented the three first models of the Salas forceps. In this article I describe the fourth and last design of my invention which has been patented in the USA as "Salas Obstetric Spatulas". It is mentioned in this article, the advantages of this instrument, which after being used in 533 applications by Dr. Fernandez del Castillo, SC and Dr. Viesca, MA they have come to the conclusion that the Salas instrument is excellent. Laufe et al in his book describe: There is no doubt that these forceps (Salas) could be made more acceptable to US practitioners. It is insisted in the modern classification of the forceps.

The low birth weight infant: is there a preferred route of delivery?

In the management of the preterm pregnancy, cesarean delivery cannot be supported in the delivery of the preterm (less than 1500 g) cephalic-presenting fetus. Although cesarean may be of benefit in the management of the preterm breech fetus (less than 1500 g), there is yet no perspective randomized clinical trial to support its use.

Instrumental (operative) vaginal deliveries: vacuum extraction compared with forceps delivery at Ilorin University Teaching Hospital, Nigeria.

In a four-year period (1984 to 1987) a total of 141 Nigerian women who had instrumental vaginal deliveries at term in the Obstetric unit of University of Ilorin Teaching Hospital, Ilorin, were studied. Out of this number 79 had forceps delivery while 62 had vacuum extraction. The forceps delivery rate had fluctuated between 0.11% and 0.46% while the vacuum extraction rate had steadily increased from 0.08% to 0.39% (Table 1) in our unit over the 4-year period. With the exception of fetal distress, there were no significant differences found in the indications for forceps delivery and vacuum extraction. The preapplication station, position and cervical dilatation differ in both groups (Table 4). There was less maternal trauma in vacuum extraction than forceps (Table 5). The vacuum extraction was more associated with cephalhaematoma and neonatal jaundice but less with neonatal mortality compared with forceps (Table 7). Vacuum extraction had gradually assumed more prominence as an alternative to midforceps delivery in our unit in the study period. There was no maternal mortality in the two groups.

The obstetric forceps--are we using the appropriate tools?

A total of 166 pairs of obstetric forceps of three different types in regular use in two major obstetric units was measured and compared with manufacturers' master instruments and drawings. As well as linear measurements of blade, shank and handle the distances between the tips and maximum distance between the blades, and the mean radius of the cephalic curve were determined. The purpose of the study was to assess the suitability of instruments in common use for present day practice. It was found that the measurements differed significantly from the original descriptions and there were wide variations between instruments of the same type, even when supplied by the same manufacturer. In some cases the blades had not been packed in matching pairs in the Central Sterile Supplies Department. It is suggested that critical reappraisal of the forceps in current use in many obstetric units is overdue. As well as a need for reconsidering the type of forceps used the dimensions of individual pairs should be checked.