The document provides a detailed overview of vacuum delivery (ventouse), a method used to assist childbirth through the application of a vacuum device on the fetal scalp. It covers historical developments, types of vacuum extractors, prerequisites, indications, contraindications, and techniques for effective application and traction. The advantages and complications associated with vacuum delivery compared to forceps are also discussed.

1. Vacuum delivery

2. Vacuum Extraction (Ventouse)
• It is an instrumental device designed to assist
delivery by creating a vacuum between it and the
fetal scalp
• In the United states - vacuum extractor
• Europe – Ventouse (French- soft cup)

3. Historical background
• In 1705, Dr.James Yonge, an English surgeon-
first description of vacuum extraction
• In 1848 -Simpson -bell shaped device called an “air
tractor vacuum extractor”
• In 1953 a metal cup extractor -Malmstrom

4. 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.

7. Types of vacuum extractors
Vacuum extractors are divided on the basis
of the type of cup- -metal
or plastic
1.Metal cup vacuum extractors
2.Soft cup vacuum extractors

8. Metal cup
• The metal-cup vacuum extractor- mushroom shaped
(40 to 60 mm =d)
• Metal-cups h`v
• higher success rate
• easier cup placement in (OP) position
• Due to rigidity of metal cups
application difficult and uncomfortable
increased risk of fetal scalp injuries.

9. Soft cup
• soft cups-bell or funnel shaped
• Soft-cup instruments- used with a manual vacuum
pump or an electrical suction device.
Soft-cup vacuum extractors- disposable or reusable
• Soft-cup vacuum extractors -fewer neonatal scalp
injuries.
• But higher failure rate

10. Prerequisites of vacuum extraction
• same as for forceps delivery
• Consent + well informed patient
• Vertex-presentation
• Head -well engaged
• No CPD
• Cervix fully dilated or almost so
• Bladder should be empty

11. Indications
INDICATED
• Maternal/Fetal distress in 2nd stage
• Prolonged 2nd stage
• Deep transverse arrest or persistent OP
• High vacuum for second twin
Prophylactic
• Preeclampsia
• Vaginal birth after CS

12. Contraindications
• Suspicion of CPD
• Other presentations than vertex like face
• Premature fetus
• Intact membranes
• Fetal coagulopathy
• Operator inexperience

13. Application of the cup
• Identification of the flexion point
-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).

16. 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 included in the cup.

17. Creating the negative pressure
For rigid cups, the negative pressure increased 0.2
kg/cm2 every 2 minutes until - 0.8 kg/cm2 is attained-
This creates an artificial caput (chignon) within the cup.
• With soft cups negative pressure can be increased to 0.8
kg/cm2 over as little as 1 minute

18. 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.

19. 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

20. Principles to be kept during traction:
• Direction of pull – should follow curve of carus
• Traction –right angles to cup and counter
pressure with left hand
• Descent should occur with each pull
• Delivery should be within 3 pulls over 15 minutes
• Between contractions, check for fetal HR and
proper application of the cup

22. Release
• When the head is delivered -vacuum is
reduced as slowly - diminishes the risk of
scalp damage
• The chignon should be explained to the
patient and the relatives

23. Reapplication of the cup
-If the cup detaches for the first time, reassess
the situation.
If favorable ,then reapply.
-If cup detaches for 2nd time, reassess if vaginal
delivery is safe or move to caesarean section
-CS-if there is inadequate descent and rotation

24. Failure of vacuum
• failed if-
-fetal head does not advance with each pull
-fetus is undelivered after 3 pulls with no
descent
-cup slips off the head twice at the proper
direction of pull with the maximum negative
pressure.

25. Advantages of Vacuum over Forceps
-Regional Anesthesia is not required
-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) -injuries to the head
is less common.
-Less genital tract lacerations.
-It can be applied on non-engaged head.
-Donot require full dilatation of cervix
-less traction force required
-promote autorotation

26. Complications
Maternal
-Perineal, vaginal ,labial, periurethral and cervical
injuries
-Annular detachment of the cervix when applied
with incompletely dilated cervix
-Traumatic PPH

27. Complications
Fetal
• Cephalohaematoma.
• Scalp injury
• Subgaleal hematomas
• Intracranial haemorrhage.
• Neonatal jaundice
• Subconjunctival haemorrhage
• Retinal hemorrhage
• Fetal death-asphyxia due to difficult vacuum extraction

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