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Vacuum delivery
Vacuum delivery is a procedure sometimes done during the course of vaginal childbirth.
Vacuum extraction recommends if you're pushing, but labor isn't progressing. If you've
never given birth before, labor is considered stalled if you've pushed for a period of two
to three hours but haven't made any progress. If you've given birth before, labor might
be considered stalled if you've pushed for a period of one to two hours without any
progress. Your baby's heartbeat suggests a problem. If your health care provider is
concerned about changes in your baby's heartbeat and an immediate delivery is
necessary, he or she might recommend vacuum extraction. You have a health
concern. If you have certain medical conditions such as narrowing of the heart's
aortic valve (aortic valve stenosis) your health care provider might limit the amount
of time you push. Indications for vacuum-assisted delivery, for the maternal need to
avoid voluntary maternal expulsive efforts (e.g., the mother has cardiac or
cerebrovascular disease), inadequate maternal expulsive efforts, maternal exhaustion or
lack of cooperation. For the baby, non-reassuring fetal heart tracing, prolonged second
stage of labor, failure to progress in second stage of labor. Caution against vacuum
extraction if: you're less than 34 weeks pregnant,your baby has previously had blood
taken from his or her scalp (fetal scalp sampling), your baby has a condition that affects
the strength of his or her bones, such as osteogenesis imperfecta, or a bleeding
disorder, such as hemophilia, your baby's head hasn't yet moved past the midpoint of
the birth canal , the position of your baby's head isn't known, your baby's shoulders,
arms, buttocks or feet are leading the way through the birth canal and your baby might
not be able to fit through your pelvis due to his or her size or the size of your pelvis.
During vacuum extraction a health care provider applies the vacuum a soft or rigid
cup with a handle and a vacuum pump to the baby's head to help guide the baby out
of the birth canal. This is typically done during a contraction while the mother pushes.
Types of vacuum extractor are metal cup and soft cup.The metal-cup vacuum extractor
is a mushroom-shaped metal cup varying from 40 to 60 mm in diameter. A centrally
attached chain connects the cup to a detachable handle that is used to apply traction. A
mechanical or electrical suction device is attached to the metal cup via a peripherally
located vacuum port. The advantages of metal-cup vacuum extraction over soft-cup
extraction include a higher success rate and easier cup placement in the
occipitoposterior (OP) position, especially when an OP cup is used.
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Unfortunately, the
rigidity of metal cups can make application difficult and uncomfortable, and their use is
associated with an increased risk of fetal scalp injuries. Metal-cup vacuum extractors are
rarely used in the United States. Compared with metal-cup devices, soft-cup vacuum
extractors cause fewer neonatal scalp injuries. However, these instruments have a
higher failure rate.Soft-cup instruments can be used with a manual vacuum pump or an
electrical suction device. Some have a built-in vacuum-release valve that allows pressure
to be rapidly attained and accurately controlled. This results in easy maneuverability and
simplicity of operation. Soft-cup vacuum extractors may be disposable or reusable.
Traditionally, the soft cups are bell or funnel shaped. A newer variety, the mushroom-
shaped vacuum cup, or M-cup, combines the advantages of soft and metal cups. The
soft sidewall of the M-cup minimizes infant scalp trauma compared with the Malmstrm
metal cup. The advantage of Vacuum extractors Easier to learn quicker delivery, less
maternal genital trauma, less maternal discomfort, fewer neonatal craniofacial injuries,
less anesthesia required. Forceps, fewer neonatal injuries, including cephalohematoma,
retinal hemorrhage and transient lateral rectus palsy. Higher rate of successful vaginal
delivery. Relative contraindications for vacuum extraction: fetal prematurity (< 34
weeks of gestation), fetal scalp trauma, unengaged head, incomplete cervical dilatation,
active bleeding or suspected fetal coagulation defects, suspected macrosomia ,
nonvertex presentation or other malpresentation , cephalopelvic disproportion, delivery
requiring rotation or excessive traction, inadequate anesthesia. Risk for the baby: scalp
wounds, an injury to the network of nerves that sends signals from the spine to the
shoulder, arm and hand (brachial plexus), collarbone fracture, skull fracture, bleeding
within the skull.