Vacuum-assisted delivery: a review

Abstract

In 1992, the number of vacuum deliveries overtook the number of forceps deliveries performed in the USA. Most clinical experiences report that the vacuum is safe for both the fetus and the mother when used properly. Correct cup placement on the fetal head and knowing when to abandon the procedure, appear to be key components to conducting a safe and successful vacuum delivery. However, the focus and training that has been afforded forceps deliveries in the past has not been given to the vacuum, because of its perceived 'ease of use'. This apparent lack of understanding has led to increasing numbers of complications associated with its use. In addition, because forceps are being taught less in training programs, fewer and fewer physicians are being trained in the essential skills of operative vaginal delivery. This review is intended to emphasize the correct techniques and skills of vacuum-assisted vaginal delivery in an attempt to increase the success and decrease the complications associated with its use.

Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey

“…Only items pertaining to commonly reported interventions and procedures in labor and birth are reported here. (17,18) Supine position for birth Second-stage bearing down is more efficient in upright positions (19).…”

The Changing Scenario of Obstetrics and Gynecology Residency Training

“…Although both forceps and vacuum deliveries have declined in numbers, vacuum deliveries have gained favor in comparison to forceps deliveries, and the majority of recently trained practicing physicians feel more confident using vacuum extractions than using forceps. [16][17][18][19] This is attributable to the safety and comfort of using the vacuum as compared to forceps. However, despite the ease of its use, training in the correct technique of vacuum application is absolutely necessary to prevent complications.…”

“…However, despite the ease of its use, training in the correct technique of vacuum application is absolutely necessary to prevent complications. 18 Also, teaching the technique of forceps application needs to be reinstated in residency programs, as obstetricians are faced with situations in clinical practice where gentle and judicious application of low forceps may be preferable over a cesarean section. 20,21 The numbers of invasive perinatal procedures (amniocentesis, chorionic villus sampling) and vaginal breech deliveries also declined significantly.…”

What do you tell the family who asks, ‘What went wrong?’ The truth and nothing but the truth

“…4 Several maternal risk factors associated with SGH were present in the case of Baby V. She was born at 34 weeks gestation to a 32-year-old gravida 2 para 0 woman. The study of 10 066 newborns by Boo et al 12 found that maternal nulliparity was one of the five significant risk factors for SGH.…”

“…3 It is formed by ruptured emissary veins that bleed into the potential space between scalp aponeurosis, or galea aponeurotica, and the periosteum of the cranial bones. 4 Suture lines do not limit this potential space, and so infants can lose up to 80% of blood volume into the area. The reported incidence of SGHs is slightly <1%.…”