Vacuum Extraction of the fetus

1. Ministry of Health of Ukraine
Donetsk National Medical University
Vacuum Delivery/Vacuum Extraction of
fetus
Teacher: Larisa Petrivna
Shelestova
By: SRISHTI GUPTA
Group: 603 A.M.
Kropyvnytskyi
2022

2. Introduction
► Vacuum extraction (VE), also known as ventouse, is a method to assist
delivery of a baby using a vacuum device. It is used in the second stage of
labor if it has not progressed adequately. It may be an alternative to a
forceps delivery and caesarean section.
► Instrumental device designed to assist delivery by applying traction to a
suction cup attached to the fetal scalp
► Any condition that threatens to mother or fetus that is likely to be relieved
by delivery.
► Fetus of at least 34 weeks for the device to be used.

5. Description of Device
► 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.

6. Types of Cups
The main difference between vacuum extractors lies in the 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 periphery of the cup
while the handle of traction is attached by a separate short metal chain to
the center of the cup
► Soft cup

8. Maternal Indications
► Maternal distress, exhaustion after a long, painful labor, due to inefficient
uterine contractions.
► Prolonged second stage of labor
Nulliparous:
❖ >3hrs with regional analgesia>
❖ 2hrs without regional analgesia
Parous:
❖ >2hrs with regional analgesia
❖ >1 hr without regional analgesia

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

10. Fetal Indications
► Prolapse of umbilical cord
► Premature separation of placenta
► Non reassuring fetal heart rate pattern
► Fetal distress
► Non rotated heads or occipitotransverse positions
► Occipitoposterior position

11. Contraindications
► Operator inexperience
► Inability to assess fetal position
► Suspicion of cephalopelvic disproportion
► Fetal coagulopathy
► Preterm babies (<34 weeks) due to risk of fetal intraventricular hemorrhage
► Macrosomia (≥4 kg)
► Soft tissues obstruction in the pelvis
► Breach presentation and face presentation

12. ► Components:
► a suction cup with four sizes(30mm, 40mm, 50mm, 60mm)
Metal cup
Soft cup
Silastic cup
Rigid plastic cup
► vacuum pump,
► traction tubing

13. Technique
► The woman's bladder should be empty (via voiding or catheterization).
► The patient is placed in the lithotomy position.
► Vaginal examination to check pelvic capacity, cervical dilatation,
presentation, position, station and degree of flexion of head and that the
membranes are ruptured
► Determination of flexion point
► Proper cup placement over flexion point
► Exclude maternal soft tissue entrapment by palpation
► Vacuum creation by increasing the suction in increments of 0.2 kg/cm2 every
2 mins until 0.8 kg/cm2

14. ► A check is made using the fingers round the cup to ensure that no cervical or
vaginal tissue is trapped inside the cup

16. ► The pressure is gradually raised at the rate of 0.1kg/cm2 per minute until
the effective vacuum of 0.8kg/cm2 is achieved in about 10 minutes time
► The scalp is sucked into the cup and an artificial caput succedaneum is
produced, which disappears within few hours.
► Instrument handle is grasped, and initiation of traction
► Traction is initiated by using a two-handed technique, i.e the fingers of one
hand are placed against the suction cup, while the other hand grasps the
handle of the instrument
► Traction is initiated by using a two-handed technique, i.e the fingers of one
hand are placed against the suction cup, while the other hand grasps the
handle of the instrument

17. ► Traction should be synchronous with the uterine contractions; released in
between the contractions.
► Once head is extracted, vacuum pressure is relieved; cup is removed; vaginal
delivery followed.
► The total time from the application until delivery should not exceed 20
minutes
► If >20 minutes, the risk of fetal scalp trauma and intracranial damage
increases
► Many pulls to achieve progress should not be done
► The operator should be wiling to abandon the procedure if it does not
proceed easily or if the cup dislodges >3 times

19. 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.

20. Fetal Complications
► Scalp laceration and bruising
► Subglial hematoma, Cephalohematoma
► Intracranial hemorrhage, intraventricular and cerebral hemorrhages
► Retinal and sub-conjunctival hemorrhages
► Neonatal jaundice
► Clavicular fracture, Shoulder dystocia
► Injury to CVI, CVII nerves, Erb palsy
► Hypoxia, particularly when extraction has taken a long time and has been
difficult
► Fetal death

24. Maternal Complications
► Soft tissues injuries such as cervical tears, annular detachment of the
cervix, vaginal tears, perineal lacerations and tears, extension of
episiotomy, vaginal wall and perineal hematomas.
► Traumatic postpartum hemorrhages
► Infection
► Genital prolapse.

25. Management
► To assess the effect on the mother and the fetus
► To start a Ringer’s solution drip and to arrange for blood transfusion,
if required
► To exclude rupture of the uterus
► To assess if procedure is to be abandoned and consider delivery by
cesarean section
► Laparotomy should be done in a case with rupture of uterus.
► To administer parenteral antibiotic