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PubMed2005

Risk factors associated with subaponeurotic haemorrhage in full-term infants exposed to vacuum extraction.

OBJECTIVES: To determine obstetric and neonatal risk factors associated with subaponeurotic haemorrhage (SAH) in infants exposed to vacuum extraction. DESIGN: A prospective observational study. SETTING: In the labour room, operation theatre, postnatal wards and neonatal intensive care unit (NICU) of a tertiary teaching hospital. POPULATION: All infants born in the hospital with a history of exposure to vacuum extraction. METHODS: A prospective observational study carried out over a 26-month period. All eligible infants were examined at birth and during the first 24 hours of life. MAIN OUTCOME MEASURES: A diagnosis of SAH was based on detection of a tender fluctuant scalp swelling that crossed the skull suture lines of infants. RESULTS: Of 10,066 infants born in the hospital during the study period, 338 (3.4%) had exposure to vacuum extraction. SAH was detected in 71 (21.0%) of them. Forward multivariate logistic regression analysis showed that five factors were significantly associated with development of SAH: maternal nulliparity (adjusted odds ratio [OR]: 4.0; 95% confidence intervals [CI]: 1.6, 10.0), failed vacuum extraction (adjusted OR: 16.4; 95% CI: 2.0, 135.6), Apgar score of less than 8 at 5 minutes of life (adjusted OR: 5.0; 95% CI: 1.7, 15.2), marks of vacuum cup over the sagittal suture (adjusted OR: 4.4; 95% CI: 1.9, 10.2) and marks of leading edge of vacuum cup at <3 cm away from the anterior fontanel of infants' heads (adjusted OR: 6.0; 95% CI: 1.7, 21.0). CONCLUSION: Maternal nulliparity, placement of vacuum extraction cup over the sagittal suture at a distance too close to infant's anterior fontanel and failed vacuum extraction predisposed infants to develop SAH.

Adult↗
PubMed1983

Vacuum extraction: use in a small rural hospital.

The effectiveness of vacuum extraction with the Silastic Obstetrical Vacuum Cup (SOVC), which has a soft, maleable cup, was assessed by two family physicians in a small rural hospital. Vacuum extraction was attempted in 35 of 231 deliveries over an 18-month period, with an overall success rate of 66%. The main indications for vacuum extraction were fetal distress, followed by a prolonged second stage of labour and malrotation of the occiput. The efficiency of the technique improved with experience. The effects of vacuum extraction on the fetus and mother compared favourably with those reported in the literature. After introduction of the SOVC, the rate of primary cesarean section for cephalopelvic disproportion declined, as did the rate of forceps delivery. Despite careful antenatal screening and referral, and the availability of alternatives, delivery by vacuum extraction with the SOVC was found to be a useful and effective adjunct to obstetric practice.

Extraction, Obstetrical↗
PubMed1994

Forceps and vacuum extraction.

The proper use of forceps or vacuum extractor, or both, remains a safe and effective modality in achieving the universal goal of a healthy mother and baby. Their use requires continued experience, sharing of information, and possibly attention to subtleties of design. This review looks at the current situation with special emphasis on side effects and selection issues as found in the recent literature.

Birth Injuries↗
PubMed1999

Use of obstetric forceps in Finland today--experience at Vaasa Central Hospital 1984-1998.

BACKGROUND: Forceps delivery has become rare in Finland since the introduction of the vacuum extractor. Our aim was to survey the number of forceps deliveries in Finland and analyze our own material of 130 forceps deliveries during a 15-year period between 1984 and 1998. During this period there were 17,887 deliveries at Vaasa Central Hospital. METHODS: A retrospective study of 130 forceps deliveries and 11 trial forceps cases, which subsequently resulted in a cesarean section. RESULTS: There was no maternal or neonatal mortality. In 39 cases a cesarean section could be avoided by use of forceps after a failed vacuum extraction. Only in one case was maternal morbidity regarded as serious. There was no serious neonatal morbidity. Anal sphincter ruptures occurred in three cases (2.3%). All the women in the trial forceps group were nulliparous, in 73% of these the fetus was in a persistent occipito-posterior position. Failed vacuum extraction and trial forceps did not significantly influence neonatal outcome. CONCLUSIONS: Forceps delivery appears to be a safe alternative in our setting.

Adult↗