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Nowadays, concerns regarding operative vaginal birth (OVB) that need to be addressed at a national and institutional level in many countries. This chapter presents general notes on vacuum extraction and forceps to assist vaginal birth. The varying circumstances of practice between countries and hospitals within countries mean that, unless a trainee has opportunities to be trained in a variety of hospitals and regions, it is unlikely that the goals of the RCOG Green-top Guideline on operative vaginal delivery will be attained. One of the purposes of this book, and the ROBuST training course that accompanies it, is to ensure that trainees have the opportunity to develop skills in both methods of OVB. In the developing countries where operative obstetric skills have been maintained, OVB is carried out when there are concerns in terms of 'fit'. Skills training workshops in emergency and newborn care are many and varied too.
Most surgical conditions that occur in the nonpregnant patient also occur in pregnancy. For a surgical problem that arises during pregnancy, the urgency of surgical treatment must be balanced against the risk that such treatment poses to the mother and the fetus. Current obstetric literature and legal case reports reveal that obstetric forceps and the vacuum extractor are coming back into the mainstream of obstetric practice. Cesarean delivery has been a major tool to assist the obstetrician in improving pregnancy outcome. Urologic injuries occurring during the course of pregnancy or more commonly during surgical or instrumental delivery, can result in serious and potentially life-threatening complications to both the mother and the unborn infant. Most urologic injuries from vaginal or abdominal surgical procedures on pregnant women involve some form of direct mechanical injury or compromise to the bladder or ureters.
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