A SAFE ALTERNATIVE TO CAESAREAN SECTION?

Summary A prospective study has been carried out over six years to determine whether or not assisted delivery before full dilatation of the cervix is a safe alternative to Caesarean section. Malmstrom's vacuum extractor was employed to accelerate the first stage of labour in 86 patients. This was successful in 82 patients, 39 being delivered with the ventouse alone, and 43 with the additional aid of forceps. In 4 patients vaginal delivery was not possible owing to unsuspected disproportion and the attempt in each case resulted in serious fetal injury or death. The results of successful vacuum extraction in 82 patients are compared with those of a similar group of 110 patients delivered with special forceps. Once the decision was taken to accelerate delivery in the first stage of labour, the time taken to deliver the baby with forceps was about one‐fifth of that required with the ventouse. When rotation of the fetal head was required prior to delivery it was achieved in all the cases of forceps delivery but failed to occur in almost half the number of vacuum extractions. There were no maternal deaths and maternal morbidity was less with each of these methods than might have been expected had Caesarean section been employed. Cervical tears occurred in 18 per cent of patients after vacuum extraction and in half this number after forceps delivery. In subsequent pregnancies these patients showed no evidence of cervical incompetence. With forceps fetal injuries were trivial, no perinatal death occurred and paediatric follow‐up has shown no permanent central nervous system damage. With the ventouse the injuries were more serious, there was a corrected perinatal mortality rate of 24 per thousand and follow‐up has revealed permanent central nervous system damage in 4·5 per cent of surviving infants.