Vacuum extractors: Description, mechanics, indications and contra-indications

CHU Saint-Jacques, service de gynécologie obstétrique, 2, place Saint-Jacques, 25030 Besançon cedex, France.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction (Impact Factor: 0.62). 12/2008; 37 Suppl 8(8):S210-21. DOI: 10.1016/S0368-2315(08)74759-8
Source: PubMed

ABSTRACT The vacuum extractor, as opposed to other instruments, does not increase the fetal head diameter for vaginal delivery. Introduced half a century ago, this device is today widely used in many countries probably because of a learning-curve which is acquired quicker than for the forceps. Major benefits obtained are the flexion of the fetal head provided that the cup is correctly placed, and the compulsory rotation induced that is most useful in the conversion of occiput posterior or transverse to anterior positions. The limitations reside in the need for maternal effort at expulsion and in the fact that it is unsuitable for face presentations. Moreover, like other instruments, the vacuum extractor can be harmful and even dangerous to the mother and her fetus. Therefore, its indications and contra-indications must be respected, and its operative use mastered with as much precision as for the forceps.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). The use of low-concentration epidural infusions of bupivacaine potentiated by morphinomimetics reduces the number of operative interventions compared with larger doses (Level A). Placement of an epidural before 3-cm dilatation does not increase the number of operative vaginal deliveries (Level A).
    European journal of obstetrics, gynecology, and reproductive biology 07/2011; 159(1):43-8. DOI:10.1016/j.ejogrb.2011.06.043 · 1.63 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Occipito-posterior presentation represents 10 to 34% of cephalic presentations in early labor. Spontaneous rotation during labor to occipito-anterior mode occurs in most cases, but 5 to 8% of fetuses will persist in posterior position for the expulsive phase of delivery. Previous research has shown that this presentation carries an increased risk of unusually long labor, maternal and fetal exhaustion, instrument-assisted delivery, severe perineal injury, and cesarean section. The diagnosis of posterior variety is usually made quite late at the end of dilation. Several researchers have reported the benefits of determining presentation during labor by transabdominal ultrasonography. Some obstetrical techniques to correct these presentations at complete dilation have also been described. In the case of diagnosis of posterior variety, the usual attitude is expectant management. Postural techniques to promote physiological labor and delivery have been documented in the literature. De Gasquet has described a very precise technique to facilitate fetal rotation, but its effectiveness has never been assessed scientifically. A Cochrane review on the topic has shown that similar positions are well accepted by women and reduce back pain. On the other hand, the sample size of included studies appeared inadequate to assess their interest for use in childbirth, in general, and for adverse outcomes associated with posterior presentation varieties in particular. Attempts to correct the fetal malposition during the expansion phase would allow to reduce adverse outcomes during the expulsive phase of delivery. Further research is necessary to assess the efficacity of specific maternal positions during labor for the correction of fetal posterior presentation.
    Gynécologie Obstétrique & Fertilité 04/2012; DOI:10.1016/j.gyobfe.2011.05.006 · 0.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: Determine cases which are at risk of vacuum extraction failure as well as maternal and foetal issues depending on the delivery outcome. MATERIAL AND METHODS: It was a retrospective study comparing 147 vacuum failures, from January 2002 to December 2010, with a control group randomly composed of 526 successful vacuum extractions. The outcomes were high risk situations of vacuum failure, maternal and neonatal morbidity depending on the delivery method (caesarean section or other instrumental extraction). RESULTS: The global vacuum failure rate was 3.3 %. During labour, we identified several situations at risk of vacuum extraction failure: cephalhematomas prior to extraction (P<0.001), deflexion attitude (P<0.001), posterior variety (P<0.001), entering above the inlet strait (P<0.001), occiput posterior delivery (P<0.001), fœtal weight greater than 3500g (P=0.023). Neonatals consequency were more Apgar score below 7 at five minutes life (P=0.007), fœtal acidosis (pH<7,20) (P=0.032), neonatal resuscitation (P<0.001), and craniofacial damages (P<0.001). CONCLUSION: Many dystocic situations occurring during labour require intense care when practicing vacuum extraction since they more frequently result in failure. In case of vacuum extraction failure, immediate adaptation to extra-uterine life seems to be more difficult for new-born babies.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 05/2013; DOI:10.1016/j.jgyn.2013.04.003 · 0.62 Impact Factor
Show more