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Application of excessive force use vs .net qr barcode printer todraw qr barcode on .net Android Every obstetrician, whethe QR Code JIS X 0510 for .NET r a trainee or a consultant, should be aware of the immortal words of Professor Sir Norman Jeffcoate, published in the British Medical Journal in 1953:. It is in the case in which forceps have been applied, and in which unexpected difficulties are encountered, that tragedy may occur. Tragedy results from a train of human reactions, which have personal pride and prestige as their basis. We have all experi enced them.

The unexpected resistance to delivery is followed by a stronger pull and then removal of the blades to confirm the position of the foetal head. Further traction with little effect brings to mind the vision of a stillbirth. Now is the time to stop, but the patient and her relatives have been prepared for forceps delivery, not Caesarean section.

Moreover, it requires much courage to admit to assistants, midwives and the onlookers that a mistake has been made and that vaginal delivery is not safe. The remote possibility of successful delivery spurs the obstetri cian to renewed and more frantic efforts. Now he is seized with dread, casts caution to the wind, and ultimately he may or may not succeed in extracting a mangled foetus, the mother also being injured in one way or another.

The situation is more dangerous if some progress is made than if the passage of the foetal head is completely obstructed. In the former case, the foetal head is crowded more and more into an ever decreasing pelvic diameter, with inevitable injury: in the latter it can come to no harm except from the pressure of the forceps themselves. One of the fears which drive the obstetrician to make frantic efforts is that the case may become one of failed forceps a label which, by tradition, involves everyone concerned with ignominy, and which itself can be responsible for bad obstetrics.

How much better it would be if it were generally recognised that even the best exponents can make a mistake occasionally, and that failure to deliver with forceps is not so great a sin as a failure. 30: Cerebral palsy to recognise defeat at an early stage. If the forceps are applied skilfully, no harm comes to the baby or to the mother, provided the attempts at extraction are discontinued immediately it becomes clear that there is greater difficulty than anticipated. All that is necessary is to have the courage to proceed to Caesarean section before the life of the foetus is jeopardised.

. The same principles apply QR Code for .NET to the use of the ventouse, which in inexperienced hands (and particularly when used in the face of more disproportion than might have been recognized) may be just as dangerous. Whichever instrument is chosen, if it is used inexpertly there can be extensive damage to the fetal head, resulting in intracerebral or intraventricular haemorrhage which, in turn, can cause cerebral palsy.

It is therefore essential that trainee obstetricians are properly instructed in the use of forceps and the ventouse. They should also be supervised by a senior, more experienced obstetrician until he or she is satisfied that the trainee has sufficient dexterity and understanding of the fetal and maternal anatomy to be able to perform assisted vaginal deliveries unsupervised..

when they are led by senio r midwives and obstetricians. Discussion of each woman s labour will include considering the potential pitfalls and problems, so that if/when a problem arises the less experienced staff will not only recognize it but will know what action to take. Over the last few years it has become common practice in the UK to have regular drills for situations such as shoulder dystocia, eclampsia, major haemorrhage and fetal distress.

These drills have proven to be very useful and often life-saving. However, they are often held in isolation, away from the labour ward, when they would be best held on the labour ward and associated with teaching and retrospective case reviews. Again, the presence of senior midwives and obstetricians at these times is invaluable, not only because of their expertise, but because they set an important precedent: they are there, where they are needed.

When there are medical students present, they should be part of the team and should be encouraged to watch and assist in the management of labour..
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