ventouse delivery, vacuum delivery techniques , indication and complications

1. VENTOUSE DELIVERY
Anjana Thomas

2. Description
 It is an instrumental device designed to assist
delivery by creating a vacuum (negative pressure)
between itself and the fetal scalp.

3. Definition
 Vaccum extraction also known as ventouse, is a
method to assist delivery of a baby using a vacuum
device. It is a instrumental delivery to assist delivery
by creating a vaccum between it and the fetal scalp.

4. Equipment Description
 Vacuum extractor is composed of:
 A specially designed cup with a diameter of 3,4,5,6
cm or 30,40,50,60 mm.
 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

5. Part
 Suction cup of variable sizes. It is either metallic or
soft made of silicone .
 Vacuum generator.
 Traction tubing.

6. Type
 Malmstrom cup
A metal cup to its centre attached a metal chain
passed through the rubber tube. The other end of
the chain is attached to a handle for traction

7.  Bird’s cup
The suction rubber tube is attached to the periphery
of the cup while the handle of traction is attached by
a separate short metal chain to the centre of the cup.

8.  Soft cup
It is a bell shaped 6.5 cm diameter soft cup which is
made of a firm but supple silastic material.

9.  Kiwi cup
It is fexible stem and low profile cup enable
placement over the flexion point of the baby’s head
no matter the fetal head position.

10. Indications
 Maternal indication
 Maternal distress: exhaustion after a long, painful
labor due to inefficient uterine contraction.
 Prolonged second stage of labor.
 Maternal medical disorders such as heart diseases,
HTN and anemia
 Previous cesarean section or genital prolapse repair.
 Premature separation of placenta.

11.  Fetal indication
 Deep transverse arrest with adequate pelvis.
 Delay in descend of the high head in case of the
second baby of twins.
 Malposition : occipitolateral and occipito posterior.
 As an alternative to forceps exept in face
presentation and brreech.
 Fetal distress

12. Contraindication
 Operator inexperience
 Inability to assess fetal position
 Suspicion of cephalopelvic disproportion
 Fetal coagulopathy
 Preterm babies due to risk of fetal intraventricular
hemorrhage.
 Macrosomia >4kg
 Soft tissues obstruction in the pelvis
 Breach presentation and face presentation

13. Condition to be fulfilled
 There should not be any bony resistance below the
head
 The head of a singleton baby should be engaged
 Cervix should be at least 6 cm dilated.

14. Prerequisites
 Bladder must be emptied
 Cervix fully dilated
 No evidence of CPD
 Vertex presentation and not above the station of +2
 Membrane must be ruptured

15. Technique
 Application
 Station of the head and its position is assessed
 Instrument is checked to be in working condition
before application
 Selection of cup is important
 The cup is introduced after retraction of perineum
with two fingers of the other hand
 The centre of the cup should be on the flexion point
of the head, which is a point located on the sagittal
suture, 3cm in front of posterior fontanelle.

16.  Traction at this point results in maximum
flexion(flexing median application)

17.  Proper cup placement over flexion point
 Exclude maternal soft tissue entrapment by
palpation

18.  Vacuum creation by increasing the suction in
increments of 0.2 kg/cm2 every 2 mins until 0.8
kg/cm2
 A check is made using the fingers round the cup to
ensure that no cervical or vaginal tissue is trapped
inside the cup .
 The pressure is gradually raised at the rate of
0.1kg/cm2 per minute until the effective vacuum of
0.8kg/cm2 is achieved in about 10 minutes time
 The scalp is sucked into the cup and an artificial

19.  Instrument handle is grasped, and initiation of
traction.
 Traction is initiated by using a two-handed
technique, i.e the fingers of one hand are placed
against the suction cup, while the other hand grasps
the handle of the instrument
 Traction must be at right angle to the cup
 Traction directed initially downward then
progressively extended upward as head emerge.
 Traction should be synchronous with the uterine

20.  Once head is extracted, vacuum pressure is
relieved; cup is removed; vaginal delivery followed.
 The total time from the application until delivery
should not exceed 20 minutes.
 If >20 minutes, the risk of fetal scalp trauma and
intracranial damage increases.
 Many pulls to achieve progress should not be done .
 The operator should be wiling to abandon the
procedure if it does not proceed easily or if the cup
dislodges >3 times

21. Vacuum application

22. Complications
 Fetal complications
 Scalp laceration and bruising
 Subglial hematoma, Cephalohematoma
 Intracranial hemorrhage, intraventricular and
cerebral hemorrhages
 Retinal and sub-conjunctival hemorrhages
 Neonatal jaundice
 Clavicular fracture, Shoulder dystocia
 Injury to CVI, CVII nerves, Erb palsy
 Hypoxia, particularly when extraction has taken a
long time and has been difficult
 Fetal death

23.  Maternal complications
 Soft tissues injuries such as cervical tears, annular
detachment of the cervix, vaginal tears, perineal
lacerations and tears, extension of episiotomy,
vaginal wall and perineal hematomas.
 Traumatic postpartum hemorrhages
 Infection
 Genital prolapse

24. Management
Along with normal delivery management :
 To assess the effect on the mother and the fetus
 To start a Ringer’s solution drip and to arrange for
blood transfusion, if required
 To exclude rupture of the uterus
 To assess if procedure is to be abandoned and
consider delivery by cesarean section
 Laparotomy should be done in a case with rupture of
uterus.
 To administer parenteral antibiotic