What is vacuum extraction?

Vacuum extraction is an unusual forceps delivery for similar indications in the second stage of labor. The conditions that need to be satisfied for any instrumental delivery need to be checked prior to application. The cups come in different sizes and are usually 4 to 6 centimeters in diameter. The cup is applied over the flexion point which is 4 centimeters in front of the occiput on the midline indicated by sagittal suture.

What is vacuum extraction?It is halfway between the two parietal eminences and hence promotes flexion to permit the minimal diameters for the vertex to descend through the pelvis. Application over the flexion point is a flexing median application. At this site the anterior margin of the cup is 4 centimeters behind the posterior margin of the anterior fontanelle along the sagittal suture. If the position is close to the occiput but not on the midline it is called flexing paramedian application. If it is in the midline but closer to the anterior fontanelle it is deflexing median and if it is off the midline it is deflexing paramedian application. Deflexing applications expose larger diameters especially if they are paramedian applications.

Vacuum ExtractionIt is essential for the man who is a midwife (accoucheur) for identification of the position of the head and to know whether the head is asynclitic so that the cup can be applied correctly over the flexion point. A specially designed cup is needed for occipito-lateral or posterior positions. The tubing should emerge from the lateral aspect of the cup or through a groove in the cup allowing the cup to be inserted and moved between the vaginal wall and the head to reach the flexion point.

Soft silk, anterior metal cup or plastic cup where the tubing comes from the centre of the cup is suitable for application when the head is in the occipito-anterior position as the flexion point is within reach when the labia are parted and the cup is advanced on to the head. These cups are not suitable for occipito-posterior or lateral positions as the lateral vaginal wall would not permit the central stem or suction tubing on the dorsum of the cup for the cup to be shifted to the occiput. Once the cup is placed firmly on the fetal scalp vacuum is created by a hand held pump or a mechanical pump with negative pressure.

vacuum extraction The positioning in relation to the sagittal suture and the posterior fontanelle should be checked and inclusion of the vaginal or cervical tissue excluded. The vacuum is increased prior to commencement of traction with uterine contractions and bearing down effort. There is no need to create the vacuum in steps of 0.2 bar every few minutes or for the release of the vacuum in between traction efforts. The traction needs to be applied in a direction to cause flexion of the head to a favorable occipito-anterior position from the occipito-lateral or posterior position.

Vacuum extraction deliveries in proportion to forceps deliveries have increased over the last decade due to evidence suggesting less perineal trauma including third degree tears. The soft tissue sucked into the cup remains as an elevated circular bump called chignon. This soft tissue swelling settles in the next three days. Neonatal injuries are scalp abrasions, retinal hemorrhages as well as haematoma confined to one of the skull bones, rarely subgaleal hemorrhage as well as neonatal jaundice which could cause severe morbidity as well as mortality. There is also an increased incidence of neonatal jaundice. Follow up studies those who had low outlet instrumental deliveries whether normal or neurological outcome.

vacuum extraction It is not used in very preterm babies and those fetuses with possible hemorrhagic tendencies for fear of causing subgaleal hemorrhage as well as morbidity or mortality. Application of the Vacuum extraction prior to full dilatation but after 8 centimeters dilated in multiparous women has been practiced by experienced personal but should be treated with caution. In those with cardiac, neurological or respiratory disease where maternal expulsive efforts may cause compromise, forceps may be better than Vacuum extraction delivery.

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