MODULE 3

VENTOUSE
 DEFINITION
• Vacuum extractor is an instrument that
applies traction
• Used as alternative to forceps
• Cup cleaves the baby ‘scalp by suction
• Used to assist maternal effort
 Indications
• Maternal cardiac, hypertensive or
respiratory disease
• Fetal compromise in second stage of
labour
• Prolonged second stage
• Poor maternal effort
 Use of ventouse
• When there is delay in labour
• Should be applied when head is engaged
• When there is no cephalopelvic
disproportion
• Used in second twin, when head remains
high
 Application of use
• Point lies on sagittal suture
• About 3 cm anterior to posterior
fontanelle
• 6 cm posterior to anterior fontanelle
• Cup is positioned over sagittal suture
• If not well placed may cause deflexion of
head
Soft & rigid vacuum extractor cups
• Metal cups
• Malstrom type
• Silicone rubber cup
• Sizes is between 4,5 and 6 cm
 Procedure
• Position the woman in lithotomy position
• Local anaesthesia may be used or inhalation
analgesia
• Pudendal nerve block may be employed or
epidural
• No routine episiotomy
• Explain procedure to woman, obtain consent
• Empty bladder
 Procedure

• Ask for help, address the client, adequate

anaesthesia
• Bladder empty
• Cervix must be completely dilated
• Determine the position of the fetus
• Equipment and extractor ready
• Fontanelle, apply the cup over the sagittal
suture
 Procedure
• For forceps birth
• Gently traction at right angles to the plane of the
cup
• Half traction and reduce the pressure, repeat the
cycle
• Incision, of episiotomy if necessary
• Jaw is reachable,remove the vacuum cup for
forceps birth
• Remove forceps before head is out to decrease
tension
 Write up procedure fully
• Time taken
• Cup type and size
• Number of pulls
• Number of detachments
 Complications
• Artificial caput succedaneum
• Scalp abrasions
• Cephalohaematoma
• Subaponeurotic bleeding
 Module 3

Birth by forceps
 Definition
• Used to expedite delivery of the head
• To protect the fetus or mother from
trauma & exhaustion
• Used to assist delivery after coming head
of breech
• To draw head of the baby up
• Out of pelvis at caesarean section birth
Classification of obstetric forceps
• Low and mid cavity
• Low cavity forceps are when head
reached pelvic floor
• Mid-cavity forceps used when presenting
part is below ischial spines
• High cavity forceps with caesarean
section
 Types of obstetric forceps
• Wrigley ‘s forceps
• Neville-Barnes or Simpson ‘s forceps
• Kielland’s forceps
 Indications
• Delay in second stage of labour
Insufficient contractions
Epidural analgesia
Malrotation of head
Maternal fatigue
 Indications
• Fetal comprise
Prematurity
Hypoxia
IUGR
maternal obstetric or medical condition
 Indications
• Maternal distress
Hypertension
Cardiac condition
Maternal exhaustion or prolonged labour
 Prerequisite for forceps delivery
• Care of bladder – must be empty
• Analgesia-epidural or pudendal block
• Information giving and consent
• Inform paediatrician
• Prepare neonatal resuscitation equipment
Precautions which must be observed
• Forceps must be done by an experienced
person
• Sagittal suture should be in direct anterior-
posterior diameter
• Head must be 0/5 palpable above the brim
• Use pudendal block for analgesia
• Cervix should be fully dilated
 Procedure
• Read through on pg 610 (myles for
midwives)
 Complications
• Maternal
Trauma & soft tissue damage on
perineum,vagina or cervix
Haemorrhage from above
Dysuria or urinary retention from bruising or
oedema of urethra
Painful perineum
Postnatal morbidity
 Complications
• Neonatal
Marks on baby’s face
Excessive bruising from forceps
Facial palsy from blade compressing the
facial nerve (temporary)
 References
• Fraser, D.M.,Cooper, M.A., & Nolte,
A.G.W.(2010) Myles for midwives.
African edition. Churchill Living stone.
Elsevier