VENTOUSE

DELIVERY
 Ventouse is an instrumental device designed
to assist delivery by creating a vacuum
between it and the fetal scalp.
INSTRUMENT
 ADVANTAGES OF VENTOUSE
 It can be used in unrotated and malrotated
occipito- posterior position of the head
 It can be applied even through incompletely
dilated cervix (first stage of labor)
 It is not space occupying device like forceps
blades
 It allows the fetal head to follow its own
mechanism of descent and rotation
 Lesser traction force is needed (10 kg)
 It can be used safely even when the head
remains at a high level and exact position is
unsure
 It is comfortable and injuries to the mother
are less
 Fetal complications are less
 Requires less technical skill (suitable for
trained midwives)
 It causes minimum trauma to the mother and
the child. The chignon formed disappears
with in 24 to 48 hours.
 Less intracranial tension
 TYPES
1.Low ventouse delivery for vertex with failure
to progress on perineal floor (only extraction)

2. Outlet Ventouse delivery for arrested

occipitoposterior positions of vertex (rotation
and extraction)
 INDICATIONS
 As an alternative to forceps operation
 As an alternative to rotational forceps as in
occipito transverse or posterior position
 Delay in descent of the head in case of the
second baby twins
 Delay in the first stage of labour (uterine
inertia)
 Maternal exhaustion
 Cut short the second stage of labor
 Fetal distress
 Deep transverse arrest
 CONTRAINDICATIONS
1. Any presentation other than vertex
(face,brow, breech)
2. Preterm fetus (<34 weeks) chance of scalp
avulsion or sub-aponeurotic haemorrhage.
3. Suspected fetal coagulation disorder
4. Suspected fetal macrosomia(4 kg or >4kg)
5. Acute fetal distress as Ventouse entails
slower delivery.
6. Following recent scalp blood sampling
7. Cephalopelvic disproportion (CPD)
8. Intrauterine death
 CONDITIONS TO BE
FULFILLED
 There should not be slightest bony resistance
below the head
 The head of a singleton baby should be engaged
 Cervix should be at least 6 cm dilated
(preferably only cervical rim may be left
behind)
 Informed consent
 Ruptured membrane
 Analgesia
 Empty the bladder
 Gestation >34 wks
 PRINCIPLES OF VENTOUSE
DELIVERY

 A Suction cup is attached to fetal scalp of

vertex where in vacuum is created between
scalp and suction cup. Thus artificial caput
(chignon) is raised. Head is pulled out by a
traction tube attached to the suction cup.
CAPUT
 TIPS FOR SAFE VACUUM
DELIVERY
 The vacuum system is checked for leaks prior
to ventouse application

 Careful vaginal examination to ensure safe

instrumental delivery. Before traction is
applied, ensure that maternal tissue is not
caught with in the cup.
 Before application of the cup identify
the sagittal suture, posterior fontanelle
and anterior fontanelle. When the cup is
applied it should be bisected by the
sagittal suture and there should be at
least 3 cm between the edge of the
cup and the anterior fontanelle (flexing
median application)
 PROCEDURE
 Preliminaries:
Local infiltration with lignocaine is usually
necessary. This can be applied even with out
anaesthesia specially in parous women. The
instrument should be assembled and the
vacuum is tested prior to its application.
 STEP1:
 Application of the cup-The largest possible
cup according to the dilatation of the cervix
is to be selected.
 The cup is introduced after retraction of
the perineum with two fingers of the other
hand.
 The cup is placed against the fetal head
nearer to the occiput with the knob of the
cup pointing towards the occiput.

 This will facilitate flexion of the head and

the knob indicates the degree of the
rotation.
 A vacuum of 0.2 kg /cm2 is induced by the pump
slowly, taking atleast 2 minutes.

 A check is made using the fingers round the cup to

ensure that no cervical or vaginal tissue is trapped
inside the cup.

 The pressure is gradually raised at the rate of 0.1

kg /cm2 per minute until the effective vacuum of 0.8
kg/cm2 is achieved in about10 minutes time.
 The scalp is sucked in to the cup and an
artificial caput succedaneum (chignon) is
produced.

 This chignon usually disappears with in few

hours.
STEP-II:

 Traction must be right angle to the cup.

Traction applied parallel to the axis of the
birth canal.

 Traction should be intermittent synchronous

with the uterine contractions. Traction also
stimulates the uterine contraction in a
hypotonic uterus.
 Traction should be made using one hand along the
axis of the birth canal .The fingers of the other
hand are to be placed against the cup to note the
correct angle of traction, rotation and
advancement of the head.

 If there is no advancement during four successive

tractions, it is to be abonded.

 On no account traction should exceed 30 minutes.

 As soon as the head is delivered, the vacuum
is reduced by opening the screw-release
valve and the cup is then detached.

 The delivery is then completed in normal

way.
 Detachment of the suction cup from the fetal head
during traction is termed a “pop –off”.

 If progress down the birth canal is not obtained

with appropriate traction or if two “pop-offs”
occur, cephalopelvic disproportion should be
suspected and the procedure should be
discontinued in favor of cesarean delivery.
COMPLICATIONS:
Fetal:
1.Superficial scalp abrasion

2. Sloughing of the scalp

3.Cephalhaematoma-due to rupture of emissary veins

beneath the periosteum (usually it resolves by one or
two weeks)

4. Sub –aponeurotic (subgaleal) haemorrhage (not

limited by suture lines as it is not subperiosteal)
5. Intracranial haemorrhage(rare)

6. Retinal haemorrhage(no long term effect)

7. Scalpinjury,lacerations,alopecia
Maternal:
The injuries are uncommon but may be due to
inclusion of the soft tissues such as the cervix
or vaginal wall inside the cup.
DISADVANTAGE :
1. The equipment is more complex and requires
more maintenance
2. The equipment is less portable than forceps
3. The time taken for delivery is a minimum of 10 to
15 minutes
4. The incidence of neonatal jaundice and fetal
hematoma is higher with vacuum than with forceps.
NURSING CARE:
 During an assisted delivery the nurse obtains
needed equipment and supplies, monitors maternal
and fetal status before, during, and after the
procedure, provides support for the mother,and
document the type of procedure as well as
maternal and fetal response.

 The nurse is aware that the use of a technique to

assist vaginal delivery may not work and anticipates
the possibility of cesaerean delivery.
 For vacuum assisted delivery inspect the infant
carefully for signs of trauma.

 Reassure the parents that exaggerated caput

(chignon) from vacuum deliveries will subside in a
few days.

 Maternal soft tissue trauma may also result from an

operative delivery.
 Inspect the perineum for bruising and
edema.

 Monitor closely for excessive bleeding or

development of hematoma.
NURSING CARE PLAN
1. Nursing Diagnosis Anxiety related to outcome of
labour.

Goal: The woman’s anxiety is reduced.

Expected outcome: Available social supports are

used. Effective coping strategies are used. Decreased
levels of anxiety are reported.
INTERVENTIONS:

 Care should be taken to attend the women

emotional needs
 Use a calm and confident manner
 Offer explanation for all procedures
 Encourage the presence of supportive family
members
2.Nursing Diagnosis Risk for injury:Postpartum
hemorrhage related to undetected lacerations or
hematoma formation.

Goal: Maternal injury from postpartum hemorrhage is

avoided

Expected outcome:
 Fundus firm and in the midline
 Lochia flow is rubra and small to moderate in
amount
 There is no bright red bleeding from any source
INTERVENTIONS:
 If the uterus feels boggy or soft to palpation
massage it until it tones up beneath fingers

 Monitor IV fluids and administer oxytocics such as

pitocin to prevent uterine atoney

 Teach women to perform periodic self fundal

massage
 Bright red bleeding that occurs in a steady stream
in the presence of a firm fundus is most likely
caused by a vaginal or cervical laceration

 Report bleeding from or separation of the edges of

the episiotomy

 Monitor for and report any very painful,soft and

possibly pulsing ,masses palpable in the perineal
area. these are signs of hematoma.
3.Nursing Diagnosis Acute pain related to episiotomy
discomfort.
Goal: The womens pain is manageable
Expected outcome:
The women report pain before it becomes severe
The woman verbalizes a tolerable pain level and
decrease in pain level after interventions
Interventions:
 make certain episiotomy is well approximated

 Apply ice back to the perineum for 20 minutes will

help to reduce swelling and painful sensations(first
24 hours)

 Warmsitz bath can be especially comforting to a sore

perineum
 Administration of analgesics
4.Nursing Diagnosis Risk for infection related to
multiple portals of entry for pathogens, including the
former site of the placenta, episiotomy, bladder and
breasts.

Goal: The women shows no signs of infection

Expected outcome: Vital signs remain within

expected limits. Fever is absent and the white blood
cell count remains with in the normal limit
Interventions:
 Use aseptic technique
 Teach the women to wash her hands before and
after eating, using the rest room and performing
perineal care.
 Monitor temperature and white blood cell count
 Instruct the women to report any vaginal discharge
with foul odor
5.Nursing Diagnosis :Disturbed sleep pattern related
to excess fatigue, overstimulation or adjusting to
newborn frequent feeding needs.

Goal: Experiences adequate amounts of restful sleep

Expected outcome: Verbalizes feeling rested with

adequate energy to care for self and infant
Interventions:

 Monitor the women sleep wake cycle

 Encourage her to continue pre sleep routines she
normally uses at home
 Promote relaxing low stress environment before
sleep
 Dim the light and monitor the noise
6.Nursing Diagnosis Risk for injury(fetal) birth
trauma related to ventouse delivery.

Goal: The fetus will avoid birth trauma

Expected outcome: No birth injury results from

ventouse delivery
Interventions:
 Rule out presentation, gestational age,
cephalopelvic disproportion, coagulation disorder,
macrosomia,fetal distress before the application of
ventouse.

 Careful vaginal examination before application of

the ventouse.

 Proper selection and application of the cup.

 Proper application of the traction.

 Inspect the newborn carefully for signs of trauma

(cephalhematoma, retinal hemorrhage, bruising,
edema, exaggerated caput(chignon).

 Reassure the parents that caput from vacuum

assisted deliveries will subside in a few days.