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Vaccum Delivery Final

Vacuum-assisted vaginal delivery (ventouse) uses suction from a plastic or metal cup placed on the fetal head to assist with delivery. It creates negative pressure between the cup and scalp to allow gentle traction. Potential complications for the neonate include superficial scalp abrasions, cephalohematoma, subgaleal hemorrhage, and rarely intracranial hemorrhage. For the mother, injuries are uncommon but may occur if soft tissues are accidentally included in the suction cup. The ventouse allows assisted delivery with less trauma than forceps and does not require as much anesthesia.

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4K views31 pages

Vaccum Delivery Final

Vacuum-assisted vaginal delivery (ventouse) uses suction from a plastic or metal cup placed on the fetal head to assist with delivery. It creates negative pressure between the cup and scalp to allow gentle traction. Potential complications for the neonate include superficial scalp abrasions, cephalohematoma, subgaleal hemorrhage, and rarely intracranial hemorrhage. For the mother, injuries are uncommon but may occur if soft tissues are accidentally included in the suction cup. The ventouse allows assisted delivery with less trauma than forceps and does not require as much anesthesia.

Uploaded by

santhiyasandy
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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VACUUM ASSISTED VAGINAL

DELIVERY (VENTOUSE)
 VENTOUSE is an
instrumental device designed to
assist delivery by creating a
vacuum between it and the fetal
scalp.
 It is traction of the fetal head by
a created
 negative pressure through a cup
applied to the head.
Instruments:
 MALSTORM DEVICE (1956) was popularized in its use,
but now there are various modifications available.
Cups:
 METAL CUPS.
 SOFT CUPS.
 SILIC CUPS (Silicon rubber or disposable plastic cups
have better adherence to the fetal scalp.
 These cups could be folded and introduced into the
vagina without much discomfort.
 Silastic cups causes less scalp trauma and there is a
chignon formation.
 Rigid plastic cup ( Kiwi, omnicup) is safe, effective
and is useful for rotational delivery.
Metal cup:
Soft cups:
Silic cups:
Cup sizes:
 A suction cup with 4 sizes (30mm, 40mm 50mm &
60mm).
Indications for operative vaginal
delivery

Maternal Fetal Others


Indications:
MATERNAL FETAL
 Inadequate expulsive  Fetal distress ( LBW
efforts. baby, Postmaturity).
 Maternal exhaustion.  After coming head of
 Expulsive efforts to be breech.
avoided. ( Cardiac  Suspicion of fetal
disease, hypertensive compromise.
crisis, cerebrovascular
diseases)
Cont.,.,
 OTHERS:
 Prolonged 2nd stage o labor (Nullipara: > 2hrs &
Multipara: > 1hr).
 To cut short the 2nd stage of labor as in (Severe
preeclampsia, cardiac disease & post cesarean pregnancy).
Contra Indications of ventouse:
 Any presentation other than vertex ( Face, brow, breech).
 Preterm fetus.
 Chance of scalp avulsion or subaponeurotic hemorrhage.
 Suspected fetal coagulation disorder.
 Unengaged fetal head.
 Obvious CPD.
 Fetus having unacute bleeding diathesis (Hemophilia).
Prerequisites for operative vaginal
delivery
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 deemly adequate.
 Bladder must be emptied.
 Adequate maternal analgesia ( Regional block for midcavity or
pudental block).
 Informed consent (verbal or written) with prior clear
explanation.
Cont.,.,.
OTHERS:
 Experienced operator.
 Aseptic techniques.
 Back up plan in case of failure.
 Willingness to abandon the procedure when difficulties
faced.
Procedure:
PRELIMINARIES
 The procedure to be followed before the operative or
manipulative obstetrics.
1. Anesthesia: Either general or local is used. (In some
cases, IV diazepam sedation is used).
2. Position: LITHOTOMY position is used.
3. Full surgical asepsis is to be taken:
Surgeon has to wear sterile mask,
gown & gloves.
Cont.,.,
 Vulva & vagina are to be swabbed with antiseptic
solution.
 Cervix is cleaned with povidone iodine solution.
 The perineum is to be draped by sterile towel and the legs
with leggings.
4. Empty the bladder:
If the patient is ambulant, she is asked to empty
the bladder before she is placed on the table, otherwise
CATHETARIZATION is to be done.
Cont.,.,
5. Vaginal Examination:
Vaginal examination must be done.
Pudental block or perineal infiltration with
1% lignocaine is sufficient.
It may be applied even without anesthesia
specially in parous women.
The instrument should be assembled and the
vacuum is tested prior to its application.
Step 1:
 Application of cup:
 The largest possible cup according to the dilatation of
cervix is to be selected.
 The cup is introduced after retraction of the perineum
with 2 fingers of the 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.
Cont.,.,
 Betadine (antiseptic) solution is applied to the rim of the
malstorm metal cup.
 A vacuum of 0.2 kg/cm2 is induced by the pump slowly,
taking at least 2 minutes.
 A check is made using the fingers round to cup to ensure
that no cervical or vaginal tissue is trapped inside the cup.
 The pressure is gradually raised at the rate of 0.12kg/cm2
per minute until the effective vacuum of 0.8 kg/cm2 is
achieved in about 10 minutes time.
Cont.,.,
 The scalp is sucked into the cup and an artificial caput
succedaneum (CHIGNON) is produced. The chignon
usually disappears within few hours.
Step 2:
Cont.,.,.
Cont.,.,
Vacuum delivery
Advantages of vacuum over forceps
 Anesthesia 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 kg/cm2)
so injuries to the head is less common.
 Less genital tract lacerations.
 Can be applied before full cervical dilatation.
 It can be applied on non-engaged head.
Disadvantages of vacuum over
forceps
 Require maternal effort
 Equipment more complex and may fail.
 Takes time may leads to fetal distress.
 Cannot be used in preterm.
 More cephalo hematoma.
Complications of ventouse:
NEONATE MATERNAL
 Superficial scalp  Uncommon injuries.
abrasion.  May be due to inclusion
 Cephalohematoma. of the soft tissues such as
 Subaponeurotic cervix or vaginal wall
(Subgaleal hemorrhage). inside the cup.
 Intracranial hemorrhage
(Rare).
 Retinal hemorrhage.
 Jaundice.

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