VACUUM

EXTRACTION(VENTOUSE)
 INTRODUCTION
• It is an instrumental device designed to
assist delivery by creating a vacuum
between it and the fetal scalp.
• In U.S the device is referred to as the
vacuum extractor whereas in Europe it is
called as Ventouse-from the French word
literally meaning soft cup.
DESCRIPTION
Vacuum extractor is composed of:
• A specially designed cup with a diameter of 3, 4,
5 or 6 cm.
•A rubber tube attaching the cup to a glass bottle
•with a screw in between to release the
negative pressure.
•A manometer fitted in the mouth of the glass
bottle
•to declare the negative pressure.
•Another rubber tube connecting the bottle to a
suction piece which may be manual or electronic
creating a negative pressure that should not
exceed - 0.8 kg per cm2.
TYPES OF VACUUM EXTRACTORS

Vacuum extractors are divided on the basis

of type of cup:
• Malmstrom cup
• Bird’s cup
• Soft cup
• Malmstrom cup:
A metal cup to its centre attached a metal chain passed
through the rubber tube.The other end of the chain is
attached to a handle for traction.

• Bird’s cup:
The suction rubber tube is attached to the peripehery of
the cup while the handle of traction is attached by a seperate
short metal chain to the centre of the cup.

• Soft cup:
It is a bell shaped 6.5 cm diameter soft cup which is
made of a firm but supple silastic material.
 MALMSTROM CUP

SOFT CUP
BIRD’S CUP
KIWI CUP
• The Kiwi OmniCup
vacuum is a disposable
one hand device.
• It consists of an palm
pump, traction indicator,
flexible stem and a cup.
• The Kiwi OmniCup is
designed for use in all
fetal head positions OA,
OP, OT and during C-
sections.
INDICATIONS
MATERNAL INDICATIONS: FETAL INDICATIONS:
• Need to avoid voluntary • Non reassuring fetal heart
maternal expulsive tracing
efforts(eg:mother has • Prolonged second stage
cardiac or of labour
cerebrovascular disease) • Shortened second stage
• Inadequate maternal of labour
expulsive efforts • Failure to progress in
• Maternal exhaustion or second stage of labour.
lack of cooperation.
• Maternal distress in 2nd
satge of labour
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
 PRE-REQUISITIES OF THE
PROCEDURE
• Procedure should be explained to the patient
and consent should be taken
• Emotional support and encouragement
• Lithotomy position.
• Bladder should be emptied.
• Antiseptic measures for the vagina, vulva and
perineum.
• Vaginal examination to check pelvic capacity,
cervical dilatation(atleast 6cm), presentation,
position, station and degree of flexion of the
head and that the membranes are ruptured.
APPLICATION OF CUP
Identification of flexion point:
• It is situated 3 cm in front of the posterior fontanelle.
• Centre of the cup should be overlying the flexion point.
This placement promotes flexion ,descent and
autorotation.

• If traction is directed from this point the fetal head is

flexed to the narrowest sub-occipitobregmatic
diameter(9.5 cm).
PRECAUTIONS
• The largest cup that can be easily passed
is introduced sideways into the vagina by
pressing it backwards against the
perineum.
• Be sure that there is no cervical or vaginal
tissues nor the umbilical cord or a limb in
complex presentation is included in the
cup.
Creating the negative pressure
• When using the rigid cups, the negative
pressure is gradually increased by 0.2
kg/cm2 every 2 minutes until kg/cm2 is
attained. This creates an artificial caput
within the cup.

• With soft cups negative pressure can be

increased to 0.8 kg/cm2 over as little as 1
minute
 EPISIOTOMY

• An episiotomy may be needed for proper

placement of the cup
• If not, then delay the episiotomy till the
head stretches the perineum or perineum
interferes with the axis of traction
• This will minimize unnecessary blood loss.
 TRACTION
• Traction should be intermittent and co- ordinated with
maternal expulsive efforts and with uterine contractions.
• Traction should be in line of the pelvic axis and
perpendicular to the plane of the cup
• Traction may be initiated by using a two handed
technique
• Fingers of one hand are placed against the suction cup
while the other hand grasps the handle of the instrument
• This allows one to detect negative traction.
• Manual torque to the cup should be avoided as it may
cause cephalhaematoma and scalp lacerations.
TRACTION CONTD....
• Between contractions, check for fetal heart
rate and proper application of the cup
• Check for sacral hand wedge if the head
has descended to the perineum with
traction but further progress is slow
RELEASE
• When the head is delivered the vacuum is
reduced as slowly as it was created using
the screw as this diminishes the risk of
scalp damage.
• The chignon should be explained to the
patient and the relatives.
REAPPLICATION OF CUP
• If the cup detaches for the first time,
reassess the situation.
• If favorable ,then reapply.
• If cup detaches for the second time,
reassess if vaginal delivery is safe or
move to caesarean section
• Caesarean section is necessary if there is
inadequate descent and rotation
Bird’s safety rules for vacuum extraction:
* The head must be completely or partially
delivered with no more than 3 pulls.
* The head is at least begin to move with the
first pull.
* The cup must not be applied more than
twice.
* Application of the cup must not exceed 20
minutes.
 Vacuum extraction is considered failed
if-
• -fetal head does not advance with each
pull
• -fetus is undelivered after 3 pulls with no
descent or after 30 minutes
• -cup slips off the head twice at the proper
direction of pull with the maximum
negative pressure.
NEWER TECHNOLOGY
COMPLICATIONS
Maternal
• Perineal, vaginal ,labial, periurethral and
cervical lacerations.
• Annular detachment of the cervix when
applied with incompletely dilated cervix.
• Cervical incompetence and future
prolapse if used with incompletely dilated
cervix.
COMPLICATIONS
Fetal
• Cephalohaematoma.
• Scalp lacerations and bruising
• Subgaleal hematomas
• Intracranial haemorrhage.
• Neonatal jaundice
• Subconjunctival haemorrhage
• Injury of sixth and seventh cranial nerves
• Retinal hemorrhage
• Fetal death
ADVANTAGES OF VACCUM OVER
FORCEPS
* Anesthesia is not required so it is preferred in
cardiac and pulmonary patient.
* The ventouse is not occupying a space beside the
head as forceps.
* Less compression force (0.77 kg/cm2) compared to
forceps (1.3
• kg/cm2) so injuries to the head is less common.
* Less genital tract lacerations.
* Can be applied before full cervical dilatation.
* It can be applied on non-engaged head.
 DISADVANTAGES
•Require maternal effort
• Equipment more complex and
may fail
• Take time in fetal distress
•Cannot be used in preterm
•More cephal heamatoma
 THANK YOU

By:
Puthenpurackal Thankamani Aparna
423 B