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2 AM, and is on the job with you

A search engine developed and sponsored by the editors of OBG Management improves the care you provide like few other resources can

December 2008 · Vol. 20, No. 12
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You are at the hospital at 2 AM, managing a nulliparous patient in the second stage of labor. Because of the mother’s exhaustion after 2 hours of pushing, you’re considering beginning vacuum-assisted vaginal delivery.

But it’s been a few months since you last performed a vacuum delivery. Optimally, you want to review the steps you’ll use to perform the operative delivery, plus the indications, contraindications, and necessary equipment.

You also realize that operative delivery may increase the risk of a third- and a fourth-degree perineal tear. You want to review the proper suturing and other steps for repairing a fourth-degree laceration.

No other physician is in the hospital at this hour to discuss these matters, so you head to a workstation and turn to the World Wide Web for assistance. But where will you search for answers to these questions that are so important in your care of this patient and her baby?

What do you do in the middle of the night when you’re alone on labor and delivery and want quick access to practical, authoritative clinical advice on how to treat your patient? This problem is a common one for all obstetricians.

Luckily, with the availability of searchable Web sites focused on obstetrics and gynecology, advice is a moment away, 24 hours a day. On the other hand, the vast storehouse of information on the Web is of variable quality, and it can be difficult to quickly find a relevant piece of information when you’re pressured to take immediate action.

Thinking about the difficulty of identifying useful clinical information fast led me to review several professional Web sites (and one general site) and their search engines by focusing on specific challenges presented in the case I’ve described. My choice of sites was based on personal experience and familiarity. I found that a few sites provide high-quality advice more quickly and reliably than several others (TABLE).

Different searches yield different results

Among the obstetrics and gynecology Web sites that I searched for clinical advice on how to perform a vacuum delivery and how to repair a third- and a fourth-degree perineal laceration, the Web sites of 1) The American College of Obstetricians and Gynecologists and 2) OBG Management (including its so-called vertical, or specialty-specific, search engine site, provided thorough advice on these topics.

The Contemporary OB/GYN Web site had valuable material on counseling but lacked thorough advice on how to perform a vacuum delivery or how to repair a third- and a fourth-degree laceration.

The Web site of The Female Patient contained an archive of past published issues but was not searchable.

The Ob.Gyn. News Web site had an excellent short article that provided clinical pearls about performing a vacuum delivery but did not contain substantive material on how to repair a laceration.

A search of did not yield detailed information about how to perform a vacuum-assisted vaginal delivery or how to repair a third- or fourth-degree laceration.

A Google search identified myriad potentially relevant sites, but most were little help to an experienced clinician. The Google search also failed to return results for the OBG Management and ACOG Web sites near the top of list.

(Note: The TABLE on provides the Web site addresses forall these sources of information and serves as a reference list for my comments.)


Information, please! (Now.)

I searched* Web sites sponsored by several publications and organizations for specific advice on 1) how to perform a vacuum delivery and 2) how to repair third- and fourth-degree perineal lacerations—and made these observations.—RLB

Web site (sponsor)

Material directly pertinent to performing a vacuum delivery?

Material directly pertinent to repairing a third- or fourth-degree perineal laceration?
(The American College of Obstetricians and Gynecologists)

Yes; PowerPoint presentation

Yes; substantial educational material on repair and on episiotomy
(Contemporary OB/GYN)

No direct advice on performing operative delivery (advice available on which patients to select for operative delivery)

No direct advice on repair (advice available on counseling patients with previous severe perineal laceration on management of subsequent delivery)
(The Female Patient)

Not searchable; provides an archive of past articles

Yes, but most practice-relevant articles are not listed at top of search results; requires significant searching, and identifying relevant articles is time-consuming
OBG Management

Yes; easily accessible, authoritative, substantive material with detailed discussion and figures

No article focused on performing an operative delivery

No article that provides clear, stepwise advice
(Ob.Gyn. News)

Yes; focused article on key relevant clinical points

No detailed discussion

*November 12, 2008

Note: This listing is alphabetized by sponsor.

It’s findit that gets it

Acknowledging some bias about OBG Management as its Editor in Chief, I do know that the editorial staff, the publication’s Board of Editors, and a team of consulting medical ontologists have worked hard—continue to work hard—to develop a fully searchable Web site that contains relevant material to help experienced clinicians at the point of care as they face difficult clinical demands. The obgfindit search engine, with its triple-pronged search “scope” (see the “Editor’s note” at the end of the Editorial for an explanation) is a state-of-the-art system for quickly identifying relevant information. And part of that system is the quick-response ability of the editorial team to modify—add to, or delete from—entries in the collective ObGyn literature, far beyond just the OBG Management archive.

Here is what I found: At OBG Management, an obgfindit search that is narrowed to the publication’s archive (to 2002) identified more than five articles written by internationally recognized experts directly pertaining to performing vacuum delivery. Each article is available in a pdf version for viewing, downloading, and printing. The articles contain high-quality figures that identify key anatomic landmarks and steps in operative delivery. Similarly, obgfindit identified two recent articles directly pertaining to the repair of severe perineal laceration, with the same pdf options. Furthermore, guidance on repairing severe perineal injury was provided by internationally recognized experts, including Drs. Abdul Sultan, Ranee Thakar, and Ruwan Fernando.

A 2-in-the-morning-alone-in-the-hospital virtual colleague

With a patient’s problem on your hands, in late-night circumstances, obgfindit can be an especially good option for finding evidence and expert opinion to guide your clinical actions. Of course, the same benefit is true at your desk, apart from urgent circumstances, when you need resources to, say, interpret findings, create a management plan, or respond to a patient’s question.

EDITOR’S NOTE: obgfindit is a no-fee, no-registration service of OBG Management available to all women’s health-care practitioners. The obgfindit search tool can be found at its own url,, or atop the home page of Users can set the limits of their search three ways: the OBG Management archive; a pool of more than 100 other selected ObGyn and women’s health Web sites; and the full PubMed literature database of the National Library of Medicine.

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