Procedure for vacuum-assisted operative vaginal delivery
- James Greenberg, MD
James Greenberg, MD
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
In 1953, the Swedish obstetrician, Tage Malmström, introduced a hollow disc-shaped stainless steel metal cup for vacuum assisted delivery . Suction tubing attached to the dome of the cup and a traction chain passed through the tubing. The Malmström cup quickly became the template for all subsequent vacuum extractor systems [2,3].
By the 1970s, the vacuum extractor virtually replaced forceps for assisted deliveries in northern European countries. However, in many English-speaking countries, including the United States and the United Kingdom, adoption of the vacuum device was slower . Nonetheless, by 1992, the number of vacuum assisted deliveries surpassed the number of forceps deliveries in the United States, and by 2000, approximately two-thirds of operative vaginal deliveries were by vacuum .
The technique for vacuum assisted operative delivery will be reviewed here. An overview of methods for operative vaginal delivery, including risks and outcomes, can be found separately. (See "Operative vaginal delivery".)
INDICATIONS AND CONTRAINDICATIONS
Indications — A vacuum assisted delivery should only be attempted when a specific obstetric indication is present [5,6]. The three major categories of indication are prolonged second stage of labor, nonreassuring fetal status, and maternal cardiac or neurological disease, but there is no absolute indication.
The indications and prerequisites for operative vaginal delivery are discussed in detail separately. (See "Operative vaginal delivery", section on 'Indications' and "Operative vaginal delivery", section on 'Prerequisites'.)
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- INDICATIONS AND CONTRAINDICATIONS
- Extractor cup
- - Soft versus rigid
- - Bell versus mushroom shape
- - Occiput posterior position
- Patient preparation
- Determine the flexion point
- Place the cup
- Apply suction
- Exert traction
- FAILED PROCEDURES
- Risk factors
- REDUCING THE RISK OF COMPLICATIONS
- Confirm correct cup placement
- Avoid entrapping vaginal soft tissues
- Know when to abandon the procedure
- COMPLICATIONS AND OUTCOME
- SUMMARY AND RECOMMENDATIONS