Vacuum Extraction

(Ventouse)

BY
DR.VASUDHA
KATURI MEDICAL COLLEGE AND
HOSPITAL
Vacuum Extraction (Ventouse)

It is an instrumental device designed to

assist delivery by creating a vacuum
between it and the fetal scalp

In the United states the device is

referred to as the vacuum extractor
whereas in Europe it is called as
Ventouse- from the french word literally
meaning soft cup.
Historical background
In 1705, Yonge described an attempted
vaginal delivery using a cupping glass

In 1848 Simpson devised a bell shaped

device called an air tractor vacuum
extractor

In 1953 a metal cup extractor was

developed by Malmstrom .
Description
Vacuum extractor is composed of:
A specially designed cup with a diameter
of 3, 4, 5 or 6 cm.
A rubber tube attaching the cup to a glass
bottle with a screw in between to release
the negative pressure.
A manometer fitted in the mouth of the
glass bottle to declare the negative
pressure.
Another rubber tube connecting the bottle
to a suction piece which may be manual or
electronic creating a negative pressure
that should not exceed - 0.8 kg per cm2.
Types of vacuum extractors

Vacuum extractors are divided

on the basis of the type of
cup- -metal or
plastic
1.Metal cup vacuum extractors
2.Soft cup vacuum extractors
VACUUM EXTRACTOR
New technology: Kiwi Omnicup
Metal cup
The metal-cup vacuum extractor is a
mushroom-shaped metal cup varying from
40 to 60 mm in diameter.
Metal-cup vacuum extractors have a higher
success rate and easier cup placement in
the occipitoposterior (OP) position,
The rigidity of metal cups can make
application difficult and uncomfortable, and
their use is associated with an increased
risk of fetal scalp injuries.
Soft cup
Traditionally soft cups are bell or funnel
shaped.
Soft-cup instruments can be used with a
manual vacuum pump or an electrical suction
device. Soft-cup vacuum extractors may be
disposable or reusable.
Compared with metal-cup devices, soft-cup
vacuum extractors cause fewer neonatal scalp
injuries. However, these instruments have a
higher failure rate.
 VE with Kiwi Omnicup

Advantages
Single operator Disadvantages
Similar performance Staff may need training
Compact, cheaper to ship Small parts can get lost
Less risk of breakage? Unknown durability
Indications of vacuum extraction

Generally vacuum extraction is

reserved for fetuses who have
attained a gestational age of 34
weeks.
Otherwise, the indications and pre-
requisites for its use are the same as
for forceps delivery(American College
of obstetricians and Gynecologists
Contraindications

Operator inexperience
Inability to assess fetal position
High station(above 0 station)
Suspicion of cephalopelvic disproportion
Other presentations than vertex.
Premature fetus(<34 weeks).
Intact membranes.
Pre-requisites of the
Procedure
Procedure should be explained to the
patient and consent should be taken
Emotional support and encouragement
Lithotomy position.
Bladder should be emptied.
Antiseptic measures for the vagina, vulva
and perineum.
Vaginal examination to check pelvic
capacity, cervical dilatation, presentation,
position, station and degree of flexion of
the head and that the membranes are
ruptured.
Application of the cup

Identification of the flexion point-

-It is situated 3 cm in front of the posterior
fontanelle.
-Centre of the cup should be overlying the
flexion point. This placement promotes
flexion ,descent and autorotation.

If traction is directed from this point the

fetal head is flexed to the narrowest sub-
occipitobregmatic diameter(9.5 cm).
Precautions-
The largest cup that can be easily
passed is introduced sideways into
the vagina by pressing it backwards
against the perineum.

Be sure that there is no cervical or

vaginal tissues nor the umbilical cord
or a limb in complex presentation is
included in the cup.
Creating the negative pressure

When using the rigid cups, the negative

pressure is gradually increased by 0.2
kg/cm2 every 2 minutes until - 0.8
kg/cm2 is attained. This creates an
artificial caput within the cup.

With soft cups negative pressure can be

increased to 0.8 kg/cm2 over as little as
1 minute
 Episiotomy

An episiotomy may be needed for

proper placement of the cup
If not, then delay the episiotomy till
the head stretches the perineum or
perineum interferes with the axis of
traction
This will minimize unnecessary
blood loss.
 Traction

Traction should be intermittent and

co- ordinated with maternal
expulsive efforts and with uterine
contractions.

Traction should be in line of the

pelvic axis and perpendicular to the
plane of the cup
Traction contd..
Traction may be initiated by using a
two handed technique
Fingers of one hand are placed
against the suction cup while the
other hand grasps the handle of the
instrument
This allows one to detect negative
traction.
Manual torque to the cup should be
avoided as it may cause
cephalhaematoma and scalp
lacerations.
Release

When the head is delivered the

vacuum is reduced as slowly as it
was created using the screw as
this diminishes the risk of scalp
damage.

The chignon should be explained

to the patient and the relatives.
Reapplication of the cup
If the cup detaches for the first time,
reassess the situation.
If favorable ,then reapply.
If cup detaches for the second time,
reassess if vaginal delivery is safe or
move to caesarean section
Caesarean section is necessary if there
is inadequate descent and rotation
 Failure of vacuum

Vacuum extraction is considered

failed if-
-fetal head does not advance with
each pull
-fetus is undelivered after 3 pulls
with no descent or after 30 minutes
-cup slips off the head twice at the
proper direction of pull with the
maximum negative pressure.
Advantages of Vacuum over Forceps

Regional Anaesthesia is not required so

it is preferred in cardiac and
pulmonary patient.
The ventouse is not occupying a space
beside the head as forceps.
Less compression force (0.77 kg/cm2)
compared to forceps (1.3 kg/cm2) so
injuries to the head is less common.
Less genital tract lacerations.
Can be applied before full cervical
dilatation.
Complications
Maternal
Perineal, vaginal ,labial, periurethral and
cervical lacerations.
Annular detachment of the cervix when
applied with incompletely dilated
cervix.
Cervical incompetence and future
prolapse if used with incompletely
dilated cervix.
 Complications
Fetal
Cephalohaematoma.
Scalp lacerations and bruising
Subgaleal hematomas
Intracranial haemorrhage.
Neonatal jaundice
Subconjunctival haemorrhage
Injury of sixth and seventh cranial nerves
Retinal hemorrhage
Fetal death
Vacuum-Assisted Vaginal
Delivery
Do not apply rocking
motion or torque,
only steady traction
in the line of the
birth canal

Stop after: three

pop-offs of
vacuum, > 20
minutes elapsed,
three pulls with no
progress
After determining position of the head, (A) insert the cup into the vaginal
vault, ensuring that no maternal tissues are trapped by the cup. (B) Apply the
cup to the flexion point 3 cm in front of the posterior fontanel, centering the
sagittal suture. (C) Pull during a contraction with a steady motion, keeping
the device at right angles to the plane of the cup. In occipitoposterior
deliveries, maintain the right angle if the fetal head rotates. (D) Remove the
cup when the fetal jaw is reachable
How to apply ventouse: