Vacuum extraction is an artificial labor, the fetus is born with negative energy

extraction (vacuum) in the head. (Capita Selecta Medicine, Volume 1; 331)

Vacuum extraction is obstetric measures aimed to accelerate spending time with
mothers pushing power synergies and extraction in infants. (Maternal and Neonatal;
495)
Vacuum extraction is an artificial labor with the principle between fetal head and
traction device to follow the movement of vacuum extractor tool. (Sarwono;
Obstetrics; 831)

Etiology
1. Fatigue in women: energy depletion mother during childbirth because of physical
exhaustion in the mother (Prawirohardjo, 2005).
2. Partus not forward: His abnormal in force or its cause that the obstacles in the birth
canal that is prevalent on every labor, not insurmountable obstacles to labor or death
(Prawirohardjo, 2005).
3. Fetal distress: Fetal Heart Rate Abnormal characterized by:
4. Fetal Heartbeat irregularity in the delivery is to react and get back some time.
When the Fetal Heart Rate does not return to normal after a contraction, at the cost of
hypoxia.

contraindications
1. Location of the face (eye damage)
2. Head breastfeeding
3. Premature Babies (tension should not be hard)
4. Fetal distress

The advantages and disadvantage Vacuum Extraction

1. Excellence Vacuum Extraction
a. Installation is easy (reducing the danger of injury and infection)
b. Not required general narcosis
c. Not add large bowl head size to go through the birth canal
d. Vacuum extraction can be worn on the head is still high and the opening of the
cervix is not yet complete
e. Trauma to the fetal head is lighter (Rustam Mochtar, 1999).
2. Losses Vacuum Extraction
a. Delivery of the fetus requires a longer time
b. Traction power is not as strong as in pliers. Actually, it is considered as an
advantage, because the fetal head is shielded from traction with excessive force.
c. Maintenance more difficult, because many of its parts are made of rubber and must
always be airtight. (Rustam Machtar, 1999).

COMPLICATIONS

On Mother:

Bleeding
Infection of the birth canal
Trauma of the birth canal

In children:

Excoriations and necrosis of the scalp

Cephal hematoma
subgaleal hematoma
intracranial hemorrhage
Subconjuntiva hemorrhage, retinal hemorrhage
clavicle fractures
shoulder dystocia
Injuries to the cranial nerve VI and VII
Erb paralysa
fetal death

The concept of Nursing

1. Assessment
Assessment is the first step of the nursing process. Assessment of right and directed
will facilitate the actions of any planning and evaluation of an act which is
implemented. The assessment was done systematically, contain objective and
subjective information from the client obtained from interviews and physical
examinations.
Assessment of post clients include:
a. client identity
Personal data clients include: name, age, occupation, address, medical record and
others - others
b. Medical history :
1) The first health history: a history of heart disease, hypertension, chronic kidney
disease, hemophilia, history of pre-eclampsia, the birth trauma, compression failure
of the blood vessels, placental implantation site, the retention of retained placenta.
2) Health history now: the perceived complaints nowadays are: loss of large amounts
of blood (> 500ml), Nadi weak, pale, lokea in red, thirst, dizziness, restlessness,
fatigue, low blood pressure, cold extremities, and nausea.
3) Family health history: their family history or are suffering from hypertension, heart
disease, and pre-eclampsia, hemopilia hereditary diseases and infectious diseases.

Nursing diagnoses that may arise

a. Impaired sense of comfort pain related with mechanical labor, childbirth
physiological responses
b. high risk of fetal trauma associated with vacuum action, prolonged labor
c. High risk of maternal trauma associated with maternal dysfunction
Nursing plan
a. Impaired sense of comfort pain related with mechanical labor, childbirth
physiological responses
Outcomes: the client says it can adapt to the pain felt
intervention:
1) Assess the needs of clients to physical touch during contraction
Rationale: touch can act as destruction, providing support and encouragement for
labor and can help maintain pain relief
2) Monitor the frequency, duration and intensity of uterine contractions
Rationale: detecting progress and observing the response of normal uterus
3) Inform the client onset of contraction
Rationale: clients can sleep and or partial amnesia between these contractions may
damage its ability to recognize contractions when contractions begin and can impact
negatively on the control
4) Give a tranquil environment with adequate ventilation, the lights dim, and no
officers were not required
Rationale: a safe environment pose, giving optimal opportunity for rest and relaxation
between contractions
5) Review / provide instruction in a simple breathing tehknik
Rationale: encourage relaxation and gives clients a way to overcome and control the
level of discomfort.

b. High risk of fetal trauma associated with vacuum action, prolonged labor
Expected outcomes: Indicates FHR within normal limits, the variability is good, no
deselarasi.
intervention:
1) Assess FHR manually or electrically, note variability, and periodic changes in the
fundamental frequency. Check FHR between contractions using doptone. Totalizing
for 10 minutes, rest for 5 minutes and count the number again for 10 minutes.
Continue this pattern throughout the contraction until the middle of them and after
contraction
Rationale: Detect abnormal response, such as the variability exaggerated, bradycardia
and tachycardia, which may be caused by stress, hypoxia, acidosis, or sepsis
2) Consider uterine pressure during rest and contraction phase through intrauterine
pressure catheter when available
Rationale: break pressure greater than 30 mm Hg or contraction pressure more than
50 mm Hg decrease or interfere with oxygenation in intravilos space.
3) Identification of maternal factors such as dehydration, acidosis, anxiety, or vena
cava syndrome.
Rationale: Sometimes a simple procedure (such as reversing the lateral recumbent
position to the client) improves blood circulation and oxygen to the uterus and
plansenta and can prevent or improve fetal hypoxia.
4) Consider the frequency of uterine contractions. Tell your doctor if the frequency of
2 minutes or less.
Rationale: contractions that occur every 2 minutes or less do not allow adequate
oxygenation of space intravilos.
5) Assess malposition using Leopold maneuver and internal examination findings (on
site and Satura cranial fontanelle). Revisit the ultrasound results.
Rationale: Determining bedside fetal, position, and presentations can identify the
factors that aggravate dysfunctional labor.
6) Monitor fetal descent in the birth canal in relation to the vertebral column iskial.
Rational: The decline of less than 1 cm / hour for primipari or less than 2 cm / hour
for multipara, may indicate CPD or malposition.
7) Set the displacement in acute care settings when malposition is detected on the
client PKA.
Rationale: The risk of injury or death fetal / neonatal increased by giving birth
vaginally if the presentation other than vertex.
8) Prepare for childbirth methods are most appropriate when the fetus at the
presentation brow, forehead and chin.
Rationale: This presentation increases the risk of CPD, because the larger diameter of
the fetal skull to the pelvis entrance (11 cm on the forehead or face presentation, 13
cm on the chin presentation.

c. Maternal high risk associated with maternal dysfunction.

Expected outcomes: birth completed without complications.
intervention:
1) Apply a sterile vaginal examination to determine the preparation and maturity of
the cervix and the fetal position, repeat as indicated by the client's reaction
Rational: soft protrusion, partial, repeated testing determines the progress of labor,
but in order to avoid infection should be restricted to a minimum
2) Check the TD and pulse every 15 minutes.
Rationale: Assessing the welfare of mothers and detect the occurrence of
hypertension and hypotension.
3) palpation of the fundus to evaluate the frequency and duration of contractions
observation overstimulation. Please note the tone intensity of rest between
contractions if the catheter is used.
Rationale: Monitoring of external uterus indicates the frequency and not the intensity
of the contraction. Excessive stimulation of uterine rupture and cause premature
placental separation.
4) Monitor inputs and outputs. Measure the specific gravity of urine, bladder
palpation.
Rationale: Decrease the risk of infection or provide early detection of infection
mikonium their content, indicating fetal distress.
5) Note the presence of abdominal cramps, headache, nausea / vomiting, their
lethargy, hypotension and tachycardia.
Rationale: water intoxication can occur depending on the speed or type of fluid given.
6) Assist as needed with intrauterine catheter.
Rationale: internal monitoring to adequately reproduce the intensity and frequency of
contractions and help identify excessive stimulation and the possibility of uterine
rupture due to excessive oxytocin administration.
7) Observe safety precaution related to the use of the infusion and appropriate
labeling on oxytocin solution.
Rationale: Errors or fluctuations in the speed of drug administration may cause
excessive given less or no adekuatan resulting contractions or rupture of the uterus.