Vacuum Delivery

Vacuum extraction (ventouse delivery): A ventouse is a birth aid that creates a vacuum between itself and the fetal scalp. Mainstream's vacuum extractor, introduced in 1954, was supposed to aid delivery by delivering traction to a suction cup attached to the embryonic scalp. It enables the extraction and delivery of the fetal head in situations where the use of obstetric forceps would be difficult or unpleasant.

Patient Selection and Pre-requisites Criteria

• The presenting part should be cephalic and, if possible, properly flexed.
• There was no evidence of a cephalic pelvic disproportion.
• High station with well-engaged head up to +2
• There is a signal to expedite delivery.
• The cervix is completely dilated.
• The obstetrician has received extensive training in the use of the tool.
• The urine bladder is completely empty.

Indication

1. Maternal indication

• Maternal anguish exhaustion caused by disorganized contractions after a lengthy, hard childbirth.
• Hypertensive condition, a maternal medical ailment similar to heart disease, causes moderate to severe anemia.
• Mature primigravida.

2. Fetal indication

• Fetal anguish
• Prolapse of the cord
• Head not rotated, occipital-transverse posture
• Position occipito-posterior
• Station +2 or slightly higher in comparison.

Contraindications

• Premature infants
• CPD to a high level
• Pelvic soft tissue obstruction
• Face and breech presentation
• Macrosomia of the high station of the head
• Fetal death in utero
• Inadequate procedure knowledge

Procedure of Vacuum Delivery

• Provide emotional support and encouragement to the patient while he or she is in the lithotomy position.
• The vulva is wrapped with sterile linen and coated with antiseptic solution. Prepare everything else as usual.
• Make that the bladder is empty, and catheterize if required.
• A comprehensive inspection of the fetal head, position of the occiput and suture lines, posterior fontanels, and assessment of pelvic and extents of cervical dilation should be performed.
• Put on personal safety barriers.
• Check all connections and run the vacuum through its paces on a gloved hand.
• Choose the largest cup that can be easily introduced and place it over the fetal scalp, with the center of the cup 2-3 cm posterior to the posterior fontanels.
• Assess the fetal head position by feeling the sagittal suture line and identifying the posterior fontanelle.
• If required, perform an episiotomy to ensure correct cup placement. If an episiotomy is not required for cup placement, wait until the head extends the perineum or the perineum interferes with the traction axis.
• Make certain that no maternal soft tissues, such as the cervical rim or virginal wall, are included in the cup.
• Make a suction of 0.2 kgcm.
• It should be gradually increased at a rate of 0.2 kgcm every 2 months to produce a negative pressure of 0.8 kgcm. Examine the cup's application.
• Once a sufficient suction force has been established, traction is applied intermittently, coinciding with uterine contractions and reinforced by maternal bearing down attempts. Traction should be maintained throughout the pains, with the direction of pull coinciding to the axis of the birth canal. This can be achieved by tugging at an angle to the cup. It also keeps the cup from sliding around.
• During traction, place a finger on the scalp adjacent to the cap to assess potential slippage and vertex fall.
• In between contractions, check FHS and cup application.
• The delivery is normally done in 3-5 pulls during a 15-minute period.
• When the head is delivered, the suction is released and the cup falls off to complete the delivery as usual.
• The total duration from application through delivery should not exceed 20 minutes, as this increases the risk of fetal scalp trauma and intracranial injury.
• IMM inject 10 units of Oxytocin for active control of the third stage of labor.
• If an episiotomy is performed, repair it.
• If the suction fails, a cesarean section should be performed.

References

• Tuitui, Roshani, and S. N. Dr. Suwal. Manual of Midwifery II (Intrapartum Care). Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014.

• www.healthline.com › Pregnancy › Preparing for Delivery

• https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

• http://www.mayoclinic.org/tests-procedures/vacuum-extraction/basics/definition/prc-20020448
• emedicine.medscape.com/article/271175-overview