Search term. Continuing Education Activity Operative vaginal delivery is used to expedite vaginal delivery for either maternal or fetal indication. Introduction Operative vaginal delivery is used to expedite vaginal delivery for either maternal or fetal indication.
Anatomy and Physiology For proper use, the maternal cervix should be fully dilated, the head engaged in the birth canal, and the head position known. Contraindications Certain fetal conditions such as fetal bleeding disorders e. Equipment Vacuum extractors often have replaced forceps when assistance is required for vaginal delivery.
Personnel Operator and at least one assistant should be present at the time of vacuum-assisted vaginal delivery. Technique After ensuring that all the prerequisites for operative vaginal delivery have been met, the vacuum cup is applied to the fetal scalp. Complications Maternal complications include the extension of vaginal lacerations, including sphincter and vaginal pain. Clinical Significance The decision to continue with operative vaginal delivery should continuously be re-evaluated during the delivery progresses.
Rocking motions and applying torque to achieve rotation should be avoided. Fewer neonatal injuries cephalohematoma, retinal hemorrhage, and transient lateral rectus palsy. Enhancing Healthcare Team Outcomes Vacuum delivery is usually only done by an experienced obstetrician.
Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Operator experience affects the risk of obstetric anal sphincter injury in vacuum extraction deliveries. Acta Obstet Gynecol Scand.
Vacuum extraction for non-rotational and rotational assisted vaginal birth. Protracted vacuum extraction and neonatal intracranial hemorrhage among infants born at term: a nationwide case-control study. Global perspectives on operative vaginal deliveries. A simple model to predict the complicated operative vaginal deliveries using vacuum or forceps. Am J Obstet Gynecol. J Obstet Gynaecol Can. Successful management of cesarean scar pregnancy with vacuum extraction under ultrasound guidance.
Acute Med Surg. Correction: Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis. BMJ Case Rep. The decision to continue with operative vaginal delivery must be re-evaluated continuously during each step of the delivery.
The maximum time to safely complete a vacuum extraction and the acceptable number of detachments is unknown. The total vacuum application time should be limited to 20 to 30 minutes. Vacuum-assisted vaginal deliveries may fail because of poor patient selection such as attempting vacuum extraction in pregnancies complicated by cephalopelvic disproportion or errors in application or technique. Failure to apply traction in concert with maternal pushing efforts or traction along the incorrect plane may also result in failed vacuum extraction.
To avoid fetal injury, the obstetric care provider should not be overly committed to achieving a vaginal delivery and should be willing to abandon the procedure if it is not progressing well. Delay may increase the risk of neonatal or maternal morbidity. The ability to perform an emergency cesarean delivery should always be at hand. There is substantial evidence that instrumental deliveries increase maternal morbidity, including perineal pain at delivery, pain in the immediate postpartum period, perineal lacerations, hematomas, blood loss and anemia, urinary retention, and long-term problems with urinary and fecal incontinence.
A randomized trial of nulliparous term deliveries showed significant maternal soft tissue trauma in Urinary and anal dysfunction including incontinence, fistula formation, and pelvic organ prolapse are additional risks of instrumental delivery that typically present months to years after delivery. Maternal morbidity from instrumental deliveries is often compared with that of cesarean deliveries because this is the most likely alternative procedure.
Compared with cesarean delivery, operative vaginal delivery is associated with less short-term maternal morbidity. Vacuum-assisted vaginal deliveries can cause significant fetal morbidity, including scalp lacerations, cephalohematomas, subgaleal hematomas, intracranial hemorrhage, facial nerve palsies, hyperbilirubinemia, and retinal hemorrhage. A California-based review of over , term singleton deliveries by Towner and colleagues 52 reported an incidence of intracranial hemorrhage of 1 in for vacuum extraction compared with 1 in for women who delivered spontaneously.
The incidence was the highest 1 in in women delivered by combined forceps and vacuum-assisted vaginal deliveries. Fetal scalp injuries associated with vacuum extraction.
Caput succedaneum scalp edema is a normal finding, but may be exaggerated by vacuum-assisted delivery. Use of a vacuum device can cause a cephalohematoma which refers to bleeding into the fetal scalp that is located in the subperiosteal space and, as such, is contained anatomically to a single skull bone or a subgaleal hematoma bleeding into the fetal scalp which is subaponeurotic and therefore not confined to a single skull bone.
The most serious complication is an intracranial hemorrhage, which includes subarachnoid, subdural, intraparenchymal, and intraventricular hemorrhage. Pediatricians should be notified whenever an operative vaginal delivery has been attempted and whether it was successful because serious morbidity can present several hours after birth. For this reason, such neonates should be closely observed.
A large prospective, observational, cohort study conducted in the Netherlands found that all vacuum-related injuries in term neonates were evident within 10 hours of birth. The authors concluded that neonates may be discharged 10 or more hours after vacuum delivery if no complications are evident. In , the United States Food and Drug Administration FDA issued a public health advisory to inform individuals that fetal complications including subgaleal hematomas and intracranial hemorrhage had been associated with vacuum extraction.
The FDA advised caution and offered a series of recommendations for the appropriate and safe use of vacuum extractor devices. Specifically, they recommended that operators refrain from rocking movements and from the application of torque rotation.
Long-term sequelae from vacuum-associated injuries such as intracranial hemorrhage and neuromuscular injury are uncommon. For example, a 9-month follow-up study of children randomized at term to vacuum versus forceps delivery found no significant differences in head circumference, weight, head circumference-to-weight ratio, testing of vision and hearing, and hospital readmission rates.
A year follow-up evaluation of children delivered at term by vacuum extraction and control patients delivered by spontaneous vaginal delivery showed no differences in fine- and gross-motor control, perceptual integration, and behavioral maturity between the 2 groups.
A number of clinical controversies still surround vacuum-assisted vaginal delivery. These are discussed briefly below. ACOG does not generally support multiple attempts at vaginal delivery using different instruments because of concerns about a higher rate of maternal and neonatal injury. A similar study by Gardella and colleagues 60 used Washington state birth certificate data linked to hospital discharge records to compare perinatal outcome in vaginal deliveries by both vacuum and forceps, vacuum deliveries, forceps deliveries, and 11, spontaneous vaginal deliveries.
The study found that the sequential use of vacuum and forceps was associated with significantly increased risk of both neonatal and maternal injury. Not all cases of intracranial hemorrhage are symptomatic. There is insufficient evidence to support the routine administration of antibiotic prophylaxis during assisted vaginal deliveries to prevent postpartum infection. A retrospective review of women compared the rates of endomyometritis among women delivered by vacuum or forceps, and found no statistical difference in the rates of infection or the length of hospitalization among those who received prophylactic antibiotics and those who did not.
Episiotomy refers to a surgical incision in the perineum designed to enlarge the vagina and assist in childbirth. Although episiotomy has often accompanied operative vaginal delivery, recent evidence suggests that routine use of episiotomy with vacuum extraction is associated with an increased rather than decreased risk of perineal trauma and rectal injuries.
Taken together, these data suggest that routine episiotomy during vacuum extraction should be discouraged. Vacuum devices can be used at the time of cesarean delivery to effect delivery of a high unengaged fetal head or as an alternative to extension of the hysterotomy when delivery of the vertex is difficult.
Once the head is visible through the uterine incision, the vacuum device can be applied directly to the vertex and delivery achieved with gentle upward traction in concert with fundal pressure. Although such an approach may reduce the risk of extension of the original hysterotomy, it is not recommended for all cesarean deliveries. There is an increasing trend toward the use of vacuum devices rather than forceps for such procedures due, at least in part, to mounting data suggesting that vacuum extraction is associated with less maternal morbidity.
To safely perform a vacuum delivery, it is important that the operator understand the indications and contraindications for this procedure. As a general rule, the soft bell-shaped cups should be used for uncomplicated occiput-anterior deliveries, whereas the rigid M cups should be reserved for more complicated deliveries such as those involving larger infants, significant caput succedaneum, occiput-posterior position, or asynclitism.
Informed patient consent must be obtained. With appropriate training and careful patient selection, vacuum-assisted vaginal delivery can be a valuable tool in the armamentarium of the practicing obstetric care provider to effect delivery of an at-risk fetus. In all instances, the potential risks and benefits of a vacuum-assisted delivery must be weighed against the available alternative, including continued expectant management, oxytocin augmentation, and cesarean delivery. No indication is absolute because the option of cesarean delivery is always available.
A number of clinical situations exist in which operative vaginal delivery should not be attempted because of the potential risks to the fetus. Soft bell-shaped cups are associated with fewer scalp injuries and no increased risk of maternal perineal injury.
Soft bell-shaped cups should be considered for straightforward occiput-anterior deliveries and rigid M cups should be reserved for more complicated deliveries. There is evidence that instrumental deliveries increase maternal morbidity. The risk of maternal injury is much higher with forceps compared with vacuum-assist devices. Vacuum-assisted vaginal deliveries can cause significant fetal morbidity.
Pediatricians should be notified whenever an operative vaginal delivery has been attempted. National Center for Biotechnology Information , U. Journal List Rev Obstet Gynecol v. Rev Obstet Gynecol. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Key words: Operative vaginal delivery, Vacuum-assisted vaginal delivery, Vacuum. Historical Perspective The first instrumental deliveries were performed to extract fetuses from women at high risk of dying due to prolonged or obstructed labor.
Indications An operative vaginal delivery should only be performed if there is an appropriate indication. Indication Definition Prolonged second stage of labor In nulliparous women, this is defined as lack of progress for 3 hours with regional anesthesia or 2 hours without anesthesia. In multiparous women, it refers to lack of progress for 2 hours with regional anesthesia or 1 hour without anesthesia.
Nonreassuring fetal testing Suspicion of immediate or potential fetal compromise nonreassuring fetal heart rate pattern, abruption is an indication for operative vaginal delivery when an expeditious delivery can be readily accomplished. Elective shortening of the second stage of labor Vacuum can be used to electively shorten the second stage of labor if pushing is contraindicated because of maternal cardiovascular or neurologic disease.
Maternal exhaustion Largely subjective and not well defined. Open in a separate window. Contraindications A number of clinical situations exist in which operative vaginal delivery should not be attempted because of the potential risks to the fetus Table 2. As we can see, use of these method is only caesarean section.
The use of fetal vacuum extractor is increasing. In Karolinska Institutet Sweden generally safe, but it can occasionally have negative study results—rates of vacuum extraction increased effects on either the mother or the child [1, 2]. The risk of This research is topical because only few studies on vacuum extraction increased with maternal age. The vacuum assisted deliveries have been published in increased use of vacuum extraction over time was Latvia till nowadays.
The initial increased use of epidural anesthesia [4]. While vacuum extractor became vacuum generator. Vacuum cups may be metal, hard widely popular in Europe, the technique was little plastic or soft plastic and may also differ in their used in the United States until after the early s, shape, size, and reusability. The soft cup is a pliable following the introduction of a series of new funnel- or bell-shaped dome, whereas the rigid type instruments, including disposable soft-cup extractors, has a firm flattened mushroom-shaped cup and Corresponding author: Diana Stepanova-Mihailova, M.
Several research fields: gynecology, obstetrics and neonatology. Metal cups provide higher success 3. Results and Discussion rates, but greater rates of scalp injuries, including Results of the study are divided into two categories cephalohematomas [].
In other study, Kuit et al. The first category includes comparisons of found that the only advantage of the soft cups was the complications between two groups, and the lower incidence of scalp injury.
Also in vacuum-assisted subgaleal hemorrhage was similar between soft and deliveries vaginal lacerations and cervical lacerations rigid cups [, 5]. In vacuum-assisted deliveries perineal are dysfunction uteri or fetal distress, prolonged lacerations were less than in control group. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Operative vaginal delivery. Obstetrics and Gynecology. Reaffirmed Wegner EK, et al.
Accessed July 9, Frequently asked questions. Gynecologic problems FAQ Assisted vaginal delivery. American College of Obstetricians and Gynecologists. Jeon J, et al. Vacuum extraction vaginal delivery: Current trend and safety. Obstetrics and Gynecology Science. Greenberg J. Procedure for vacuum-assisted operative vaginal delivery. Gabbe SG, et al.
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