Baby Extractors, Forceps Defended

Vacuum extractors and forceps are as safe for delivering babies as Caesarean sections when mothers have difficult labors, a new study shows.

The Food and Drug Administration warned in May 1998 of a tiny but growing number of head injuries and deaths among infants delivered with vacuum extractors, and it advised doctors to exercise caution when using the devices.

However, a study reported in today's New England Journal of Medicine suggests that difficult labor itself, as much as the method of delivery, may lead to brain injuries and deaths in babies.

In addition, vacuum extraction is generally safer for the mother than the use of forceps or Caesarean sections, said Dena Towner of the University of California at Davis, the study's lead author.

Caesarean sections typically are performed when labor stalls in the early stages or if the baby is in an awkward position. Vacuum extraction or forceps should be used only during the last stage--when the mother's cervix is fully dilated--and if the baby's head is in the proper position, Towner said.

Most vacuum extractions "are done for maternal exhaustion--Mom just can't push any more," Towner said. "Most babies that are in the right position, one or two little pulls and they're out."

Dialysis, Transplants Compared

People who receive kidney transplants live an average of 10 years longer than similar patients on dialysis, a study finds.

The link between a healthy transplanted kidney and longer life appears obvious. However, the study, published in today's New England Journal of Medicine, is the first to show that transplant patients not only have a better quality of life by avoiding dialysis, but also live much longer than they would without a transplant.

It looked at 228,552 people diagnosed with end-stage kidney disease from 1991 to 1997. Of those, 46,164 were placed on the transplant waiting list, and 23,275 of the waiting-list patients received a transplanted organ from someone who died. A small percentage of the transplant recipients received organs from living donors, usually family members.

The study found that patients on the waiting list were healthier to begin with than other patients on dialysis.

The researchers then compared waiting-list patients who got transplants with their counterparts on dialysis with the same age, sex, race and severity and cause of disease.

The average transplant recipient lived another 20 years, while the average waiting list patient who instead remained on dialysis lived another 10 years. The increase in life expectancy was an average of 13 years for infants, children and teenagers; 17 years for adults ages 20 to 39; 11 years for those ages 40 to 59; and four years for adults ages 60 to 74.

The study, led by Robert Wolfe at the University of Michigan, found the risk of death to be almost three times higher among the transplant patients in the days immediately following surgery. But once they got through the first few months, when organ rejection is most likely, the excess risk disappeared.