Obstetrics Book

Delivery

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Vacuum Assisted Delivery

Aka: Vacuum Assisted Delivery
  1. See Also
    1. Forceps Assisted Delivery
  2. Epidemiology
    1. Vacuum deliveries accounted for approximately 4% of all live births in 2004
    2. Contrast with forceps deliveries which accounted for 1% of all live births in 2004
  3. Efficacy
    1. Vacuum extraction has a 1.7 Odds Ratio of higher failure than forceps
    2. Failure rates are higher with soft vacuum cups than with rigid vacuum cups
      1. Rigid vacuum cups fail in 10% of cases
      2. Soft vacuum cups fail in 22% of cases (but have a lower risk of scalp injury)
  4. Indications
    1. Suspicion of fetal compromise (e.g. nonreassuring Fetal Heart Tones)
    2. Maternal exhaustion
    3. Prolonged second stage of labor
      1. Nulliparous: Failed preogression over 3 hours with anesthesia and 2 hours without
      2. Multiparous: Failed preogression over 2 hour with anesthesia and 1 hours without
  5. Contraindications
    1. Cephalopelvic Disproportion
    2. Fetal head not engaged
    3. Gestational age earlier than 34 weeks
    4. Known fetal disorders predisposing to complication
      1. Bone mineralization disorders
      2. Bleeding Disorders
    5. Malpresentation
      1. Noncephalic presentation
      2. Face Presentation
      3. Occipitoposterior presentation is not a contraindication to Vacuum Assisted Delivery
        1. However, anal sphincter LacerationIncidence approaches 33%
  6. Complications
    1. See Assisted Delivery Complications
  7. Precautions
    1. Vacuum can do as much or more damage as forceps
    2. Criteria to discontinue (prevent Subgaleal Hemorrhage)
      1. No progress after 3 pulls
      2. No baby extraction in 30 minutes after initiation
      3. Cup disengages 3 times
      4. Significant fetal scalp or maternal Trauma
  8. Preparation
    1. See Preparation for Assisted Delivery
  9. Technique
    1. Apply Suction cup during contraction
    2. Decrease cup pressure to 100 mmHg between contractions
    3. No traction until cup pressure >400 mmHg
    4. Gentle steady traction during contraction only
      1. Maintain pressure of 400 to 600 mmHg
    5. Apply one hand on vacuum traction handle
      1. Apply other hand on cup and fetal presenting part
      2. Maintain suction seal
      3. Assist slight posterior direction
      4. Prior to clearing pubic symphysis
    6. Episiotomy at crowning as needed for Fetal Distress
    7. Remove cup at crowing as Mandible presents
    8. Perform a thorough exam of mother and baby
  10. References
    1. Hook (2008) Am Fam Physician 78(8): 953-60 [PubMed]
    2. McQuivey (2004) J Matern Fetal Neonatal Med 83(5): 466-70 [PubMed]

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