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.

Vacuum-assisted cesarean section

“…In accordance with the instructions provided by Bofill et al,17 the cup should be placed over the flexion point, ~3 cm anterior to the posterior fontanelle along the sagittal suture. This is the point at which the mentovertical diameter crosses the sagittal suture, promoting flexion of the fetal neck and thus presenting the smallest diameter of the fetal head to the uterine incision 7. 3) Posterior-designed cups allow easier maneuverability of the vacuum device over the flexion point within the confines of the uterine incision.…”

“…However, complications such as scalp abrasions, retinal hemorrhages, jaundice, and cephalohematomas have been reported with vacuum-assisted operative vaginal delivery 7. More serious complications can include intracranial hemorrhages and skull fractures; however, these rare events are likely associated with misplacement of the cup, excessive traction force, and multiple pop-offs during operative vaginal deliveries 20,21.…”

“…Once established as a safe and effective method of operative vaginal delivery,7,8 vacuum-assisted procedures have more recently shown clinical utility and have become widely adopted for cesarean section 9. In an elective cesarean section, the lower uterine segment is commonly not elongated or effaced by labor, making it difficult to create an adequate incision to enable an uncomplicated delivery.…”

Is There a Role for Cerebral Ultrasonography in Near-Term/Term Neonates Following Assisted Vaginal Delivery? A Prospective, Single-Center Study

“…The reported rate of vaginal operative delivery (VOD) ranges between 12 % and 15 % of all deliveries [1][2][3]. Since maternal as well as infantile outcomes depend on rapid termination of the delivery [4], assisted vaginal delivery is used to accelerate the second stage of labor [5]. In these circumstances, vacuum extraction or delivery by forceps is useful and safe [1], if applied correctly.…”

“…A major complication during VOD is pop-off of the cup resulting in intracranial pressure fluctuations and secondary intracranial bleeding [14]. Moreover, the duration of vacuum extraction should not exceed 20 minutes, and should be limited to 3 tractions on the infant´s head [15][16][17], thus reducing the rate of neonatal trauma, and the need for intensive care treatment [5,[15][16][17]. However, serious complications like skull fractures or intracranial hemorrhages are rare when instruments are used correctly and operators are properly trained [14].…”