Vacuum Extraction / Ventouse delivery/
Vacuum extraction is accomplished by use of a specialized vacuum extractor, which has a cap like suction device that can be applied to the fetal head to facilitate extraction. Traction is applied by means of a chain and the fetal head is drawn out of the vagina.
Indications for use of vacuum extraction are similar to those for forceps application. in addition, vacuum extraction can be safely used through a partially dilated cervix to shorten fist-stage labour in some cases.
· Mild fetal distress
· in the second stage of labour of late first stage.
· Malposition; occipito lateral and occipito posterior positions
· Maternal exhaustion
· Profound fetal or maternal distress requiring rapid delivery
· Evidence of cephalopelvic disproportion
· Face or breech presentation
· The pre requisites are as for forceps delivery with the possible exception of full dilatation of the cervix.
· The head must be engaged.
· The woman is positioned and prepared as for forceps delivery.
· The position of the fetal head is determined
· An appropriately sized cup selected. The cup is placed against the fetal head as near to the occiput as possible, ensuring that no cervix is trapped beneath it.
The vacuum is then built up gradually, usually starting at 0.2 kg/cm2 is reached after 5-10 minutes once this pressure has been obtained the operator exerts steady gentle traction on the fetal head, in conjuction with uterine contractions and the mother's expulsive efforts. The suction device should be kept in place no larger than 20 to 30 minutes, and slippage or "pull off" should be avoided because it can cause trauma to fetal scalp or maternal tissue.
· Maternal – trauma to the mother is rare, if the cup is applied carefully.
· Fetal – The most common complication of ventouse delivery is trauma to the fetal scalp and some
obstetricians prefere not to use it for this reason.
Chignon –this is an area of oedema and bruising where the cup was applied. Cerebral trauma