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PubMed2004

Vacuum-assisted delivery: a review.

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.

Birth Injuries↗
PubMed2003

Vacuum application through a nonfully dilated cervix: a viable option.

The aim of this cross-sectional study was to assess the feasibility of vacuum delivery through a nonfully dilated cervix. The study group consisted of 39 women with vacuum deliveries through a nonfully dilated cervix larger than 9 cm and station of the head at S or more +2 cm. These were compared to a control group of 215 vacuum deliveries at a fully dilated cervix and 46 women who underwent cesarean section at a nonfully dilated cervix larger than 9 cm. The main indication for vacuum extraction in the study group was fetal distress and in the control groups prolonged 2nd stage, dysfunctional labor and fetal distress. Maternal and neonatal morbidity was low and not different between the groups. Neonatal well being, evaluated by cord pH and 5-min Apgar score, was not different. Based on predefined criteria, vacuum extraction through a nonfully dilated cervix is a viable alternative to emergency cesarean section and is apparently not associated with higher maternal or infant morbidity.

Apgar Score↗
PubMed1986

Vacuum extractor: a safe instrument?

One thousand five hundred and twenty-six records of deliveries with vacuum extractor in 1982 and 1983 in the Hong Kong University Department of Obstetrics and Gynaecology were reviewed. Vacuum extractor was found to be easy and safe to use even by inexperienced house-staff. Vacuum extractor was especially useful in the delivery of malpositioned fetal heads because of its mechanism of allowing autorotation. Its advantage of not occupying extra space in the pelvis was most beneficial to the relatively smaller Chinese pelvis. Maternal injury was uncommon. Fetal scalp injury like cephalhaematoma was not uncommon but serious scalp injury was infrequent. Perinatal mortality rate attributed to the instrument was low (0.6/1,000). However, in order to achieve safety to the mother and fetus, strict rules in application of the vacuum extractor must be observed.

Apgar Score↗
PubMed1982

The use of the vacuum extractor in a Nigerian hospital.

The use of the vacuum extractor over a 5-year period is reviewed. The instrument was used on 319 occasions, with a 2.8% failure rate and a 25 per thousand corrected perinatal mortality. The maternal morbidity attributable to the use of the instrument was low. The main indications for use were to expedite labor either in the first or second stage because of maternal or fetal distress, and in the rotation and subsequent delivery of the malpositioned vertex. It was found to be particularly useful for the platypellic pelvis with an android tendency, a type rather common in Nigerian parturients.

Birth Injuries↗
PubMed1984

Clinical assessment of the Kobayashi vacuum extractor.

Four hundred and thirty-one vacuum extraction deliveries were reviewed during a five-year period from 1978 to 1983. All cases involved the use of the Kobayashi silastic cup vacuum extractor with nine participating obstetricians performing the procedures. Specific attention was directed toward maternal and fetal morbidity associated with the use of the silastic cup extractor. No maternal or fetal deaths occurred. Vaginal and cervical lacerations accounted for a 4% maternal morbidity rate. Seventy-five percent of the infants had Apgar scores greater than 7 at one minute, and 97% had scores greater than 7 at five minutes. Fetal morbidity was impressively low, with a cephalohematoma rate of 6% and only two instances of major fetal cranial hemorrhages. In comparison with the reported morbidity sited by other authors using the metal cup extractor, less fetal scalp trauma may be anticipated with the judicious use of the Kobayashi silastic cup vacuum extractor.

Apgar Score↗
PubMed1988

Retinal hemorrhages and traction forces in vacuum extraction.

The relationship between the traction forces used in 53 clinically indicated vacuum extractions and the incidence and degree of retinal hemorrhages observed in the neonates within 24 hours after birth was examined. A Vacuum Extractor Recorder (Type SF 30, Knick), was used to measure the traction force necessary for delivery of the fetal head. No relationship could be demonstrated between the force time integral and the appearance and grading of retinal bleedings.

Adult↗
PubMed2005

Obstetric maternal outcomes at Bella Coola General Hospital: 1940 to 2001.

OBJECTIVE: To describe obstetric procedures (episiotomy, forceps, vacuum extraction, caesarean section) and maternal outcomes for patients who gave birth in an isolated, rural hospital. DESIGN: A retrospective cohort study. STUDY POPULATION: Women beyond 20 weeks' gestation who gave birth between Mar. 7, 1940, and June 9, 2001, inclusive, at the Bella Coola General Hospital (BCGH). MAIN OUTCOME MEASURES: Data collected included maternal age, date of delivery, mode of delivery (vaginal delivery v. cesarean section), whether an episiotomy was performed or not, if forceps or vacuum extraction were used, whether analgesia, sedation or anesthesia was used, and maternal mortality. RESULTS: There were 2373 deliveries, including 12 sets of twins. There were no maternal mortalities. Cesarean sections were not routinely performed until the 1970s. Since then, there has been an increase in cesarean section rates to 11% of all deliveries in the 1990s. In the 1940s 28% of deliveries involved an episiotomy. This increased to 47% in the 1970s and was followed by a sharp decline to 4% in the 1990s. There was an increase, followed by a more gradual decrease in the use of forceps, and there was a recent increase in the use of vacuum extraction. The changes in procedure rates appear to reflect best practice guidelines of the times. In the case of episiotomies, the data suggest rural physicians are capable of rapid incorporation of recent recommendations. Rates for all procedures tended to be lower than those reported elsewhere in Canada and the United States. Narcotics, sedatives, inhalation agents and regional anesthetics were used to relieve the pain of labour and delivery throughout the study period. CONCLUSIONS: Women giving birth in the low technology environment of the BCGH experienced relatively low obstetric procedural rates with excellent maternal outcomes.

Anesthesia, Obstetrical↗
PubMed1979

[The effect of antibiotic prophylaxis in vaginal obstetric procedures (author's transl)].

202 cases of vaginal obstetric procedures (forceps and vacuum extraction, breech delivery and manual removal) were reviewed with regard to assessing the value of prophylactic administration of antibiotics. Criteria for the evaluation were fever post partum, duration of stay in hospital and involution of the uterus. The results showed that the prophylactic administration of antibiotics had no significant effect on these parameters, with or without the simultaneous administration of oxytocics. Hence, in view of the risk of allergic reactions, toxicity and the selection of resistant strains the prophylactic administration of antibiotics does not seem to be justified in vaginal obstetric procedures. Scrupulous aseptic precautions during all vaginal or intrauterine procedures are considered essential for the prevention of infection.

Adult↗
PubMed1984

Fetal heart bradycardia associated with the vacuum extractor. A case report.

The vacuum extractor has been gaining acceptance in the United States. As a result, physicians are becoming aware of potential problems with its use. We treated a patient for fetal bradycardia attributable to the negative pressure of the vacuum apparatus. This type of fetal heart bradycardia can be distinguished from "true" fetal distress by disconnecting the vacuum apparatus and observing the fetal heart rate response. Bradycardia caused by the negative pressure of the vacuum apparatus returns to normal after instrument disconnection.

Adult↗
PubMed1992

Vacuum extraction, bone injury and neonatal subgaleal bleeding.

In a population of 27 flemish newborns with subgaleal bleeding encountered within a period of 6 years, we studied the obstetrical, clinical and radiological data. In contrast with controversial findings from the available literature, there is little doubt that difficult, often elective vacuum extraction is the main cause of this neonatal emergency. Disturbances in haemostasis, when documented, were attributed to focal intrahaematoma consumption, except for one boy who presented with haemophilia and neonatal subgaleal bleeding. Conventional X-ray examination continues to be of importance for the documentation of suture diastasis, fissures and fractures. CT scan reveals both the amount of extra-osseous bleeding, the degree of bone displacement and injury as well as the type and extent of associated intracranial damage. Subgaleal haemorrhage rarely hides a growing synchrondrosal rupture.

Birth Injuries↗
PubMed2006

Palpatory diagnosis of plagiocephaly.

INTRODUCTION: The term plagiocephaly, from the Greek plagios (oblique) and kephalê (head), means distortion of the head, and refers clinically to cranial asymmetry. Cranial Osteopathy, since it was first proposed, has focussed upon the diagnosis and treatment of birth trauma and cranial asymmetries, and consequently specific therapy for plagiocephalic deformities has been described. Osteopathic manipulation also has been proposed as a treatment for torticollis, a condition associated with plagiocephaly. For these reasons, we decided to look at the mechanics of the occipital bone and the adjacent atlas and bones of the cranial base, in relation to functional plagiocephaly. METHODS: The records of 649 children seen in an osteopathic practice in Lyon, France, were reviewed retrospectively, in compliance with the legal requirements of the Commission Nationale de l'Informatique et des Libertés (CRIL) and the Helsinki accord, for gender, age at presentation, birth history, obstetrical data (breech presentation, vacuum extraction, forceps delivery or Caesarean section), presenting complaint, side of posterior plagiocephaly, side of frontal plagiocephaly, torticollis, motion pattern of the occipital bone upon the atlas, and motion pattern of the spheno-occipital synchondrosis. RESULTS: We found significant correlations between plagiocephaly (right/left) and primipara (P=0.024), use of forceps (P=0.055) and extractor suction (P=0.055). Correlations were also found between flattening of the occiput (right/left) and lateral strain of the spheno-occipital synchondrosis (P=0.002) and between plagiocephaly (right/left) and occipito-atlantal motion (P=0.000). CONCLUSION: We found a significant correlation between the lateral strain pattern of the spheno-occipital synchondrosis and plagiocephaly and between rotational dysfunction of the occiput upon the atlas and the side of posterior plagiocephaly. We suggest that thorough neonatal osteopathic examination can identify individuals predisposed to develop posterior plagiocephaly.

Atlanto-Occipital Joint↗
PubMed2006

Decision-to-delivery interval for instrumental vaginal deliveries: vacuum extraction versus forceps.

OBJECTIVE: The aim of this study was to assess the decision-to-delivery interval for forceps delivery and vacuum extraction. STUDY DESIGN: A retrospective analysis of all instrumental deliveries over a 1-year period in a delivery ward of a university tertiary health care facility was performed. The decision-to-delivery interval was compared between forceps delivery and vacuum extraction. RESULTS: The decision-to-delivery interval was 8.6+/-5.4 and 13.8+/-6.2 min for forceps and vacuum deliveries, respectively (P=0.0001). CONCLUSION: It appears that it is quicker to accomplish forceps delivery than vacuum extraction.

Decision Making↗