VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY- DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS. VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.

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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