Vacuum-Assisted Delivery

Vacuum extraction
 also known as “ventouse”
 a method to assist delivery of baby using vacuum device.
 used in the 2nd stage of labor if it has not progressed adequately.
 an alternative to a forceps delivery and cesarean section.

Vacuum extractors
 replace forceps for many situations in which assistance is required to achieve vaginal delivery.
 Compared with metal-cup vacuum extractors, soft cup devices are easier to use and can cause fewer neonatal
scalp injuries. However, they detach more frequently.
 These devices should be employed when indicated, usually for a no reassuring fetal heart tracing or failure to
progress in the 2nd stage of labor.
 Complications may be minimized if physician recognizes contraindications to the use of vacuum extraction.
 Complete documentation is essential.

Maternal indications
1. Maternal distress – exhaustion after a long, painful labor due to inefficient uterine contractions.
2. Prolonged 2nd stage of Labor
o Nulliparous: > 3 hrs. with regional analgesia
> 2 hrs. without regional analgesia
o Parous: > 2 hrs. with regional analgesia
> 1 hr. without regional analgesia

3. Maternal medical disorders – such as heart disease, hypertensive disorders, and moderate to severe anemia
4. Previous cesarean section or genital prolapse repair
5. Intrapartum infection – certain neurological conditions.

Fetal indications
1. Prolapse of umbilical cord
2. Premature separation of placenta
3. Non reassuring fetal heart rate pattern
4. Fetal distress
5. Non rotated heads or occipitotransverse positions
6. Occipitoposterior position

Prerequisites for Vacuum Assisted Vaginal Delivery

 Complete cervical dilatation
 Ruptured membranes
 Vertex presentation
 Head engaged with position known
 Empty bladder
 No fetopelvic disproportion
 Adequate analgesia
 Cesarean section capability
 Experience operator

Vacuum Delivery Complications

 Neonatal Maternal
 Intracranial hemorrhage  Vulvar hematomas
 Intraventricular hemorrhage  Vaginal hematomas
 Subgaleal hemorrhage  Urinary tract injuries
 Retinal hemorrhage  Anal sphincter injuries
 Cephalohematoma
 Scalp lacerations
 Brachial plexus injury secondary to
shoulder dystocia

Contraindications
 Fetal prematurity
 Non- vertex presentation, malpresentations
 Fetal scalp trauma
 Unengaged head
 Incomplete cervical dilatation
 Active bleeding/ suspected fetal coagulation defects
 Suspected macrosomia
 Cephalopelvic disproportion

Advantages
 Technically easy to perform.
 Can handle mal- rotation
positions of fetal head.
 Low maternal birth canal
Vacuum extraction
injury.
Disadvantages
 Weak pulling power
 Suction sometimes fails
 Cup slips off if caput
succedaneum is large.
 Unsuitable for premature delivery.
 Can cause fetal head
complications.

 Fetus can be delivered in short  Requires experience for technical

time. proficiency.
 Strong pulling power  High risk of injury to birth canal.
Forceps delivery  Delivery of the fetus is highly  Risk of injury to face and head of
reliable fetus.
 Can performed even with
caput succedaneum.