II. Preparation

  1. Preparation for Forceps Assisted Delivery
  2. Preparation for Vacuum Assisted Delivery

III. Complications

  1. Maternal: Third and fourth-degree Lacerations
    1. Spontaneous Vaginal Delivery: 1.7%
    2. Vacuum extraction: 9.3% risk
    3. Forceps delivery: 19.2% risk
  2. Fetal
    1. Retinal Hemorrhage: Odds Ratio 2.0 higher risk with vacuum more than forceps
    2. Cephalohematoma: Odds Ratio 2.4 higher risk with vacuum more than forceps
    3. Subgaleal Hemorrhage

IV. Technique: (Mnemonic - ABCDEFGHIJ)

  1. Anesthesia adequate?
    1. Perineal Local Anesthesia
    2. Pudendal Block
  2. Bladder empty?
    1. Straight catheterize for urine as needed
  3. Cervix Completely dilated?
  4. Determine head position
    1. Be alert for Shoulder Dystocia
  5. Equipment ready?
    1. Confirm that forceps interlock
    2. Test suction on Vacuum extractor
    3. Replace Scalp Electrode with External Fetal Monitor
  6. Fontanelles ascertained (Position for safety)
    1. Vacuum
      1. Vacuum cup centered on the flexion point
      2. Position vacuum cup anterior to Posterior Fontanelle by 1 cm
      3. Position vacuum cup behind the Anterior Fontanelle
    2. Forceps (for trained and experienced forceps users)
      1. Position
        1. Forceps positioning
      2. For
        1. Forceps Fenestrations (very little of hole palpable)
      3. Safety
        1. Sagittal Suture in line with forceps
  7. Gentle steady traction (Pajot's Maneuver)
    1. Vacuum should only be applied during contraction
  8. Halt traction between contractions
  9. Incision or Episiotomy
    1. When head is being delivered as perineum distends
  10. Jaw seen
    1. Remove Forceps or vacuum as jaw is delivered

V. References

  1. (2005) ALSO Course

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