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Procedure for vacuum-assisted operative vaginal delivery

James Greenberg, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Vacuum extraction accounts for over 80 percent of operative vaginal deliveries in the United States [1]. 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 — 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 [4]. 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.

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Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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