This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.

2. “ Ventouse is an instrumental device
designed to assist delivery by creating a
vaccum between it and the fetal scalp.”
The pulling force is dragging the
cranium while in forceps, the pulling
force is directly transmitted to the base
of skull.

3.  Ever since Malmstrom in 1956 reintroduced and
popularized its use, various modifications of the
instruments are now available.
 Each, however, consists of the following basic
components:
1. Suction cup with 4 sizes (30,40,50,60 mm)
2. A vaccum pump with a manometer attached
to it (modern vaccum extractors consists of
an electrical pump)
3. Traction rod device
4. Rubber tubing with a chain in the centre.

4.  Metal cups were initially used.
 Soft cups, silc cups (silicone rubber or
dispossable plastic- mityvac cups) have better
adherence to the fetal scalp.
 These cups could be folded and introduced into
the vagina without much discomfort.
 Silastic cup causes less scalp trauma and there
is no chignon formation.
 Rigid plastic cup (Kiwi Omnicup) is safe,
effective and is useful for rotational delivery.

7.  Deep transverse arrest with adequate pelvis.
 Delay in descent of the high head in case of
second baby of twins.
 As an alternative of forceps operation except:
a. Face presentation and after coming head of breech
b. Fetal distress or prematurity
c. Delay in late first stage of labour due to uterine
inertia or primary cervical dystocia
d. As an adjunct to symphysiotomy
e. Prolonged second stage of labour
f. If rotation of caput from posterior to anterior position

8.  Unengaged fetal head
 Obvious CPD
 Paient's Refusal
 Fetus having unacute bleeding
diathesis (hemophilia).

9. FETAL & MATERNAL CRITERIA
Fetal head engaged (head is ≤ 1/5 palpable
per abdomen)
The cervix must be fully dilated
The membranes must be ruptured
Fetal head position is exactly known
Pelvis deemed adequate
Bladder must be emptied
Adequate maternal analgesia
Informed consent

10. OTHERS
 Experienced operator
 Aseptic techniques
 Back up plan in case of failure
 Presence of a neonatologist
 Willingness to abandon the procedure when
difficulties faced

11.  It can be used in unrotated or malrotated head
(OP, OT position). It helps in autorotation
 It is not a space occupying device likee the
forceps blades
 It is comfortable and had lower rates of
maternal trauma and ganital tract lacerations
 Analgesia need is less. Pudendal block with
perineal infiltration is adequate but for
forceps regional or general anesthesia is
often needed.

12.  Reduced maternal pelvic floor injuries and is
advocated as the instrument of first choice
 Perineal injury (3rd and 4th degree tears) are
less compared to forceps.
 Postpartum maternal discomfort (pain) are
less compared to forceps.
 Easier to learn comparing to forceps
 Simplicilty of use in delivery makes it
convenient to the operator (suitable for
trained midwives)

13. PRELIMINERIES
Anesthesia - Pudendal block or perineal
infiltration with 1% lignocaine is sufficient.
It can be applied even without anesthesi in
parous women.
The patient should be placed in lithotomy
position
Full surgical sepsis is to be taken
Bladder must be emptied.
Vaginal examination is done.
The instrument should be assembled and the
vaccum is tested prior to its application.

15.  The largest possible cup according to the
dilatation of the cervix is to be selected.
 The cup is introduced after retraction of the
perineum with two fingers of the other hand.
 The cup is placed against the fetal head nearer
to the occiput (flexion point) with the “knob” of
the cup pointing towards the occiput.
 This will facilitate flexion of the head and the
knob indicates the degree of rotation.
 Betadine solution is applied to the rim of the
malmstrom metal cup.

16. Flexion or pivot point is an imaginary site
located midsagitally aout 6 cm from the centre
of the anterior fontanallae or about 3 cm front
of the posterior fontanallae.

17. PRESSURE & DURATION OF VACCUM
A vaccumof 2.0 kg/cm2 is induced by the pump
slowly, taking at least 2 minutes.
A check is made using the fingers round the
cup to ensure that no cervical or vaginal tissue is
trapped inside the cup.
The presure is gradually raised at the rate of 0.1
kg/cm2 per minute until the effective vaccum of
0.8 kg/cm2 is achieved in about 10 minutes time.

18. CHIGNON FORMATION
 The scalp is sucked into the cup and an
artificial caput succedaneum / chignon is
produced.
 The chignon usually disappears within few
hours.

19.  Traction must be at right angle to the cup
 Traction should be synchronous with the
uterine contractions
 Traction is released in between uterine
contractions
 Traction should be made using one hand along
the axis of the birth canal.
 The fingers of the other hand are to be placed
against the cup to note the correct angle of
traction, rotation and advancement of the head.

20.  Operative vaginal delivery (Forceps/vaccum)
should be abandoned, where there is no
descent of the presenting part with each pull or
when delivery is not imminent after three pulls
with correctly applied instruments by an
experienced operator.
 On no account, traction should exceed 30
minutes.
 As soon as the head is delivered, t vaccum is
reduced by opening the screw-release valve
and the cup is then detached.
 The delivery is then completed in the normal
way.

21. Application of vaccum extractor A, B, C,
indicating the directions of traction at
different stations of the fetal head.
Traction over the flexion point either by
ventouse / forceps promotes flexion and
presents smaller diameter to the pelvis.

22. FETAL
 Superficial scalp abrasion
 Sloughing of the scalp
 Cephalhematoma due to rupture of emissary
veins beneath the periosteum. Usually it
resolves by one or two weeks
 Subaponeurotic hemorrhage
 Cerebral trauma (tentorial tear)
 Jaundice
MATERNAL
 Lacerations of cervix or vaginal wall.

23. FETAL
 Sloughing of the scalp
 Cephalhematoma
 Subaponeurotic hemorrhage (not limited by
suture line as it is not subperiosteal)
 Intra-cranial hemorrhage (rare)
MATERNAL
 The injury may be due to inclusion of the soft
tissue such as the cervix or vaginal wall
inside the cup.