Vacuum delivery

Question 1

what are maternal indications for a vacuum (3)

Answer 1

1. Poor maternal expulsive effort
2. Conditions in which expulsive efforts should be avoided (i.e.,
   cardiac disease, h/o stroke)
3. pre eclampsia/ eclampsia

Question 2

what are fetal indications for vacuum? (3)

Answer 2

1. fetal distress in 2nd stage
2. prolonged 2nd stage
3. failure of head to rotate

Question 3

what are the maternal pre-requisites to perform vacuum (6)

Answer 3

1. Fully dilated cervix

2. Ruptured membranes

3. No signs or symptoms of cephalopelvic disproportion
4. Empty bladder

5. Adequate analgesia

6. Adequate contractions


Question 4

what are fetal pre-requisites for vacuum (3)

Answer 4

1. Term or late preterm (GA > 34
   wks) fetus
2. Vertex presentation
3. Head at ≥ 0 station or ≤ 2/5
   above symphysis pubis (descent) (engaged head)

Question 5

how does the procedure work (7)

Answer 5

1. Make sure theater space is available when attempting an operative vaginal delivery
2. Use aseptic technique
3. Performed by obstetrician or experienced/trained midwife
4. Explain procedure and provide emotional support and encouragement to mother (who should continue to
   push if not contraindicated)
5. For vacuum application

   - Identify the posterior fontanelle

   - Place cup ~2-3 cm anterior to posterior fontanelle
 (that is the flexion point)
   - Check that there is no maternal tissue trapped within cup
   - Create vacuum seal slowly from 0.2 kg/cm2 to 0.8 kg/cm2
6. Pull in direction of birth canal axis (initially, downward and forward) with each contraction; expect descent with each combination of pulling and maternal pushing
7. Proceed to Caesarean delivery if there is no descent after 3 pulls or after 30 min or 3 pop-offs occur.

Question 6

what are maternal and fetal contraindications of vacuum delivery (7)

Answer 6

Maternal
1. CPD (severe molding, caput, blood in urine bag)
2. Intact membranes
3. HIV/AIDs
4. unconscious patient
Fetal
5. Prematurity- risk of intraventricular hemorrhage
6. fetal bleeding disorders
7. non engaged head

Question 7

what are complications of vacuum (4)

Answer 7

1. cephalohematoma
2. brachial plexus
3. maternal injury- lacerations
4. intraventricular hemorrhage

Question 8

what is a mnemonic for vacuum delivery (10)

Answer 8

A
- Address the patient
- Ask for help
- Anesthesia adequate?
B
- Bladder empty
C
- Cervix must be completely dilated
D
- Determine position of head
- Think of Dystocia
E
- Equipment ready
F
- Place cap in proper position to posterior Fontanelle
- Feel for maternal tissue before and after suction
G
- Gentle traction following the pelvic curve
H
- Halt traction between contractions
- Halt procedures if pop-off 3 times
- Halt procedure if no progress in 3 pulls
- Halt procedure after 30 minutes of use
I
- Incision: evaluate for episiotomy when crowning
(episiotomy not usually recommended)
J
- Remove cup when Jaw is reachable