Procedure for vacuum-assisted operative vaginal delivery
- James Greenberg, MD
James Greenberg, MD
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Vacuum extraction accounts for over 80 percent of operative vaginal deliveries in the United States . 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 — An operative vaginal delivery (vacuum or forceps) should only be attempted when a specific obstetric indication is present [2,3]. 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 more detail separately. (See "Operative vaginal delivery", section on 'Indications' and "Operative vaginal delivery", section on 'Prerequisites'.)
Contraindications — Suspected fetal-pelvic disproportion is a contraindication to any instrumental vaginal delivery.
Historically, experts have recommended avoiding use of vacuum devices to assist delivery before 34 weeks of gestation due to a perceived increased risk of birth injuries in preterm infants. In a registry review of 40,764 preterm births in Sweden, 3.3 percent of preterm births <34 weeks of gestation were delivered by vacuum extraction despite this recommendation . Intracranial hemorrhage was more common before 34 weeks. While these data were gathered retrospectively and confounded by indication, avoiding vacuum extraction in pregnancies less than 34 weeks is a prudent approach.
Prior scalp sampling or multiple attempts at fetal scalp electrode placement are relative contraindications to vacuum extraction because theoretically these procedures may increase the risk of cephalohematoma or external bleeding from the scalp wound.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INDICATIONS AND CONTRAINDICATIONS
- Choice of vacuum versus forceps
- 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
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS