This document provides information on assisted vaginal delivery. It describes the learning outcomes as understanding the indications, prerequisites, and contraindications for assisted delivery using vacuum extraction or forceps. It discusses that assisted vaginal delivery can help shorten prolonged second stage labor, expedite delivery for unstable mothers, and assist with occiput posterior positions or fetal distress. The document outlines the necessary conditions, equipment, application and extraction procedures for vacuum extraction, as well as complications and indications for forceps delivery or alternative procedures if vacuum extraction fails.
This document provides information on assisted vaginal delivery. It describes the learning outcomes as understanding the indications, prerequisites, and contraindications for assisted delivery using vacuum extraction or forceps. It discusses that assisted vaginal delivery can help shorten prolonged second stage labor, expedite delivery for unstable mothers, and assist with occiput posterior positions or fetal distress. The document outlines the necessary conditions, equipment, application and extraction procedures for vacuum extraction, as well as complications and indications for forceps delivery or alternative procedures if vacuum extraction fails.
This document provides information on assisted vaginal delivery. It describes the learning outcomes as understanding the indications, prerequisites, and contraindications for assisted delivery using vacuum extraction or forceps. It discusses that assisted vaginal delivery can help shorten prolonged second stage labor, expedite delivery for unstable mothers, and assist with occiput posterior positions or fetal distress. The document outlines the necessary conditions, equipment, application and extraction procedures for vacuum extraction, as well as complications and indications for forceps delivery or alternative procedures if vacuum extraction fails.
This document provides information on assisted vaginal delivery. It describes the learning outcomes as understanding the indications, prerequisites, and contraindications for assisted delivery using vacuum extraction or forceps. It discusses that assisted vaginal delivery can help shorten prolonged second stage labor, expedite delivery for unstable mothers, and assist with occiput posterior positions or fetal distress. The document outlines the necessary conditions, equipment, application and extraction procedures for vacuum extraction, as well as complications and indications for forceps delivery or alternative procedures if vacuum extraction fails.
• Developing countries: less than 1% (Bailey 2005)
6 Options for AVD
7 Vacuum extraction
• Indications • Conditions necessary • Pre procedure preparation • Procedure • Post procedure actions
8 AVD: Indications
• Shorten duration of second stage if prolonged
• Expedite second stage of labour of clinically unstable
pregnant women
• Assist delivery in occipito-posterior
• Fetal distress
9 Conditions necessary
• > 36 weeks pregnancy (use with caution between 34 & 36
weeks gestation)
• Live baby in cephalic presentation (fresh stillbirth)
• Cervix fully dilated
• Fetal head at station 0 or not more than 1/5 palpable above symphysis pubis
• Cooperative mother with good contractions
10 Pre-procedure: preparation • Explain the procedure and gain consent
• Ensure respectful care
• Wash hands with soap & water or use antiseptic hand rub (dry with sterile cloth)
• Gloves
• Clean vulva
• Drape
• Make sure urinary bladder is empty
• Pudendal block usually not necessary but perform perineal infiltration
if episiotomy is anticipated 11 Pre-procedure: assembly
Choose apparatus • Kiwi : Hard / Soft • Malmstrom (Bird): Large / Medium / Small
Check apparatus • Functioning? • Familiar?
Check suction on gloved hand
12 Types of equipment
13 Procedure: application
• Assess position of fetal
head by feeling sagittal suture line and fontanelles • Identify posterior fontanelle
14 Procedure: application
• Explain to mother • Apply largest possible cup • Place centre of cup 2-3 cm anterior to the posterior fontanelle • Insert gently and apply to flexion point • Check application • Ensure no soft tissue in rim of cup
15 Procedure: application
16 Procedure: application
• Create a vacuum of 0.2kg/cm2 (Yellow)
• Check application of cup • Increase vacuum to 0.8kg/cm2 (Green) • Check application of cup • Ask woman to tell you when next contraction starts
17 Procedure: traction
• With each contraction ask
the mother to push
• Place finger on scalp next
to cup to assess descent and potential slippage
• Start traction in line of
pelvic axis and perpendicular to cup
18 Procedure: traction • Between contractions, check fetal heart rate and application of cup
• Do not pull if no contraction
• Decide if episiotomy indicated
• Continue pulls for
maximum of three contractions if no progress
19 Procedure: action
• When head is delivered release the vacuum and remove cup
• Deliver baby in normal way
20 Post procedure actions
• Active management of third stage
• Repair any perineal trauma (tear or episiotomy)
• Write up notes for the procedure
• Observe baby for complications (12-24hrs)
• Neonatal review where available
21 Failed vacuum extraction
Classify as ‘failed’ if:
• Fetal head does not advance with each pull • No descent to pelvic floor after maximum of three contractions/pulls • Cup slips off the head twice at proper direction of pull with maximum negative pressure
