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Vacuum
the vacuum extractor is an obstetrical forceps
outlet, low and mid applications as for forceps rotation procedures are not to be performed
If a person deficient in dexterity could succeed in applying the (vacuum) tractor ...it is quite probable that he would produce as much injury as benefit...
Hayes, 1831
Indications
Fetal - suspected fetal compromise requiring
immediate delivery
Maternal
prolonged second stage maternal conditions which contraindicate pushing conditions requiring a shortened second stage exhaustion
maternal
Contraindications - Absolute
nonvertex, face or brow presentation
unengaged vertex
incompletely dilated cervix
Contraindications - Relative
prematurity or EFW < 2500 g mid-pelvic station unfavourable attitude
Control descent/expulsion
Apply the rule of threes; stop procedure
Axis of Parturition
Vacuum Application/Traction
Incorrect
Correct
reapplying
After 30 minutes of application with no progress
reassess
VACUUM MNEMONIC
Forceps Delivery
Function of Forceps
obstetrical forceps are for the following functions:
traction of the fetal head rotation of the fetal head flexion of the fetal head extension of the fetal head
these functions cause fetal head compression proper use minimizes this compressive force
Indications
Fetal
Maternal
prolonged second stage maternal conditions which contraindicate pushing conditions requiring a shortened second stage maternal exhaustion deflexed attitudes of the fetal head and malposition
Prerequisites head engaged cervix fully dilated and ruptured membranes exact position of the head determined adequate pelvis bladder empty appropriate anaesthesia experienced operator adequate facilities and backup available
Forceps must never be before full dilatation or with an unengaged vertex
labia
fetal skull has reached the pelvic floor
the sagittal suture is in:
AP diameter or right/left occiput anterior or posterior position fetal head is at or on the perineum
ACOG: "Committee in Obstetrics, Maternal and Fetal Medicine"
Low Forceps leading point of the skull is at station + 2 cm or more two subdivisions:
rotation of 45 degrees or less rotation more that 45 degrees
Mid Forceps
head is engaged leading position of the skull is above station + 1 cm alternative to mid forceps delivery is cesarean
Station
Engagement
when the biparietal diameter of the head enters the plane of the pelvic inlet when the leading edge of the skull is at or below the ischial spines (station 0)
one finger breadth above the plane of the shanks with the lambdoid sutures a fingerbreadth above each blade
Fenestrations of the blades should be barely felt and
no more than a finger tip should be able to be inserted between the blade and the fetal head
Sagittal suture perpendicular to the plane of the
shanks
Axis of Parturition
Traction
1) Direction 2) Amount
Head Compression
Rotation
Incorrect (Ouch!)
Correct
FORCEPS MNEMONIC
delivery by intended method cesarean delivery maternal analgesia requirements maternal and neonatal morbidity
anesthetic
Less maternal vaginal/perineal trauma
Documentation of Operative Delivery the procedure must be clearly recorded in every case
this documentation should provide an
Need for Intervention must be: convincing, compelling, consented to, charted
VACUUM EXTRACTION AUDIT TOOL Patient Demographics Indications Prerequisites Procedure Outcome