Vacuum extraction - An overview

Posted by e-Medical PPT Thursday, September 20, 2012
Vacuum is an operation for the delivery of the fetal head from the mother by use of a vacuum extractor applied to the fetal scalp on presence of maternal  effort
Indications
Prophylactic  : to cut short 2nd stage in conditions where
(i) mother cannot or should not bear stress of 2nd stage due to maternal condition which may exacerbate e.g..  Hypertension , DM, PIH, severe anemia, Eclampsia
(ii) due to presence of obstetric conditions such as
1.previous LSCS :
    Instrument used : Flexible, or malmstrom.
2.Prolonged 2nd stage : (failure to progress in 2nd stage )2 hrs. in c/o primi without analgesic or 3 hrs. with analgesic and 1 hr. in c/o multi without analgesic or 2 hrs. with analgesic
iii) Maternal distress
(iv) Fetal distress in 2nd stage of labor (used in 15% of cases ).
In those cases of fetal distress where delivery is imminent (reasonable strength) and labor is progressing well (not in continuation with late 1st stage  delay).
i.e. fully dilated or even > 7 cm dilatation when disproportion is not a clinical question.
Always keep facilities for LSCS ready
use of forceps by some preferred as faster
use of silastic / plastic suctions
(vi) Occipitoposterior position (POP) Bird’s modification cup
(vii) To end trial of labor successfully in borderline CPD : Attempted delivery.
In presence of preparation : The instrument of choice is circumstances where fetal distress is not present and trial of midpelvic extraction is contemplated

Non conventional uses in obstetrics
1. To deliver 2nd of twin  if   head is presenting part .
Advantage : After confirming presentation and station of the head of 2nd twin , increase oxytocin infusion.
When vacuum extractor is applied promptly it produces negative pressure which grasps the fetal head with out loss of station and when traction is produced with uterine contractions – prompt delivery is achieved.
2.To deliver head at LSCS in following  conditions :
Large head
Thin lower uterine segment in women with narrow pelvis predisposes to laceration when manual extraction of fetal head is performed  so
ventouse helps to prevent manipulations which may endanger integrity of lower uterine segment
3. To deliver frank breech : cup is applied on anterior buttock (charmers) . Obsolete.
4. prolapsed cord in 2nd stage of labor
5. To arrest brisk hemorrhage in minor degree placenta praevia with vertex presentation.obsolete.

Contraindications
Absolute :
Moderate to severe (i.e. true CPD/macosomia) vaginal delivery is not possible
Abnormal presentations should not be applied
due to possibility of fetal injury
technical problem of achieving proper seal

Relative Contraindications
Prior scalp sampling of blood for fetal gases
(studies have found no unstances of neonatal exsanguinations in these cases
Prematurity (<36 wks)
except in c/o twins as their delivery requires minimal traction due to dilatation of Cx and Vagina
cause : due to large concern over intracranial injury,ICH, Neonatal jaundice in some studies
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