Bibliographic record
Abstract
Operative delivery-in the delivery room or operating room?The topic of guidelines is a recurring theme in recent issues.When I was a resident, almost all vaginal instrumental deliveries were attempted in the labour and delivery room, and nearly all succeeded.I well remember the occasional panic of finding that vaginal delivery was not going to be successful and that a caesarean section would be necessary.As many studies find that failed attempted vaginal instrumental delivery is associated with a substantially increased risk of poor neonatal outcome, every subsequent minute of delay while the theatre was being prepared for a caesarean section felt like an hour.Gradually, one learned to try and anticipate the more difficult cases and move the parturient into theatre before attempting the delivery.This subsequently developed into a standardised practice and led in the UK to guidelines that can be found at www.rcog.org.uk/resources/Public/pdf/operative_vaginal_delivery.pdfGradually, however, as obstetricians in the UK became so reluctant to face the criticism that would probably follow a failed attempt at operative vaginal birth in the labour and delivery room, moving the woman to the operating room (O.R.) became commonplace.On page 603, Olagundoye and Mackenzie report that in Oxford (England) during a period of 3 months from the first of June 2005 if the Royal College of Obstetricians and Gynaecologists' guidelines had been followed, 107 of 229 operative vaginal deliveries would have been carried out as a trial in the O.R.In fact, 60 were transferred to the O.R. for their operative delivery, but of these, only eight actually required caesarean section.Of the 169 not transferred, only one caesarean section proved to be necessary.Moreover, transfer to the O.R. produced a substantial delay in delivery, probably resulting in substantial stress to the mother and to a lesser extent to the fetus and staff.On page 519, Vacca in his commentary highlights the important role of skill and judgement in achieving good outcomes from operative vaginal delivery and once again emphasises the important role of practical training in developing these vital attributes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.055 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.010 | 0.008 |
| Insufficient payload (model declined to judge) | 0.397 | 0.217 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".