VACUUM EXTRACTOR

Dr.K.J.JACOB
Addl PROFESSOR DEPT OF OB&GYN GOVT.MEDICAL COLLEGE , THRISSUR

EMERGENT DELIVERY IN THE SECOND STAGE

CESAREAN SECTION INSTR. DELIVERY
Potentially difficult instr.Deliveries having avoided and replaced by C.S Ventouse is the preferred instrument
EXCEPT IN SITUATIONS LIKE
Operator more experienced in forceps More traction than offered by V.E reqd Large caput ,prematurity,face, non vertex

ADVANTAGES OF THE VE
1. EASY TO LEARN & OPERATE 2. CAUSE LESS MATERNAL TRAUMA
No need of insertion of instr.In between fetal head and vagina Facilitate rotation of the fetal head without impinging upon maternal soft tissues 3. CAUSE LESS FETAL INJURY Built in safety mechanism-cup separation /pop off, When excess traction force is used 4. OPERATION FEASIBLE WITH INCOMPLETELY DILATED CX & INCOMPLETELY ROTATED HEAD

VACUUM DEVICES
METAL CUP MALMSTROM,BIRD SILASTIC CUP KOBAYASHI 1973 PAUL DEVICE (Disposable plastic replica of
Malmstrom cup), Mityvac

M-CUP (Semi rigid plastic cup)

FLEXING POINT
PROPER CUP PLACEMENT IS IMPORTANT IN THE
SUCCESSFUL CONDUCT OF VACUUM DELIVERY FLEXING POINT A POINT LOCATED ON THE SAG.SUTURE 3 CM IN FRONT OF THE POST.FONTANELLA TRACTION WITH CUP PLACED ON THIS POINT WILL RESULT IN MAX.FLEXION OF A SYNCLITIC HEAD AND SUCCESSFUL DELIVERY

PREREQUESITES

APPROPRIATE SKILL & EXPERIENCE NEED FOR EMERGENCY DELIVERY INFORMED CONSENT EMPTY BLADDER FULLY DIALATED CERVIX ENGAGED FETAL HEAD POSITION, STATION & ATTITUDE KNOWN NO FETOPELVIC (CPD) DISPROPORTION

INDICATIONS
FETAL INDICATIONS
FETAL DISTRESS POTENTIAL FETAL JEOPARDY

MATERNAL INDICATIONS
MATERNAL DISTRESS/ EXHAUSION POTENTIAL RISK OF MATERNAL DISTRESS
(IF SECOND STAGE IS PROLONGED / NEED TO STRAIN)

PROLONGED SECOND STAGE

CONTRAINDICATIONS
FACE or OTHER NON VERTEX PRESENTATION

EXTREME PREMATURITY
FETAL COAGULOPATHIES KNOWN MACROSOMIA RECENT SCALP BLOOD SAMPLING

SPECIAL SITUATIONS
CORD PROLAPSE SECOND OF THE TWINS

ROTATIONAL DELIVERY

TECHNIQUE
PROPER CUP PLACEMENT
CUP SHOULD BE PLACED OVER THE FLEXING/PIVOT
POINT ASSYMETRICAL / ANTERIOR PLACEMENT WILL CAUSE ASYNCLITISM / CERVICAL SPINE EXTENSION

ENSURE NOTHING IS ENTRAPPED BETWEEN THE CUP & SCALP

NEGATIVE PRESSURE CREATED .8Kg/CmSq or 550mm of Hg

(RAPIDLY WITH SILASTIC CUP)

TRACTION
DIRECTION OF TRACTION
Depend on station & along the curve of carus Ensure traction is perpendicular to the plane of the cup ( let the fetal head take the least resistance path)

AMOUNT OF TRACTION
Not more than the vacuum pressure Guaged by the non dominant hand with fingures on the scalp and thump on the cup

TRACTION (contd)
SHOULD COUNCIDE WITH UT.
COTRACTIONS
And maternal bearing down efforts

DELIVERY OCCURS WITH 2-3 PULLS AND

IN 10mts
Ensure advancement with each pull Reassess/abandon if no appreciable progress with 3 -4 pulls / repeated cup pop off occurs Duration of operation should not exceed 20-30 mts

COMPLICATIONS
DEPEND ON
SKILL OF THE OPERATOR CASE PROFILE Feto pelvic relationship Station & position Resistance of the mat. Soft tissue
PROCEDURE RELATED PROBLEMS Undue force of traction, Multiple traction, Multiple cup separation, Prolonged application, & Sequential instrumentation

NEONATAL COMPLICATIONS
RARE MAY CAUSE
SCALP ABERRATIONS/BRUISING CEPHAL HEMATOMA RETINAL HEMORRHAGE IC HEMORRHAGE SUBGALEAL HEMORRHAGE

SAFE GUARDS IN VACUUM EXTRACTION

PROPER SELECTION OF THE CASE
(PELVIS, STATION ,POSITION, CX)

USE APPROPRIATE DEVICE

(FLEXED SYNCLITIC HEAD AT OUTLET SILASTIC CUP)

PLACE THE CUP ON / NEAR THE FLEXING POINT

MAX: VACUUM PRESSURE - 0.8Kg/cm Sq. TRACTION AT Rt ANGLES TO THE CUP TRACTION ALONG WITH CONTRACTIONS &MAT.STRAINING

SAFE GUARDS IN VACUUM EXTRACTION

DELIVERY SHOULD BE EFFECTED WITHIN 3 -4 PULLS MAX: DURATION OF TRACTION LIMITED TO 30 Mts LIMIT THE NO. OF UNINTENDED CUP SEPARATION TO 2-3 ABANDON IF NO PROGRESS WITH TRACTION/ REPEATED CUP POP OFF (MAX 3) AVOID SEQUENTIAL INSTRUMENTATION INFORMED CONSENT & DOCUMENTATION

Dr.K.J.JACOB