Overview

Vacuum Delivery is an instrumental delivery procedure used to assist vaginal delivery by applying suction to the fetal scalp. It is an alternative to forceps delivery.

Vacuum delivery is crucial for expediting delivery in cases of fetal distress, maternal exhaustion, or prolonged second stage of labor. It is generally safer than forceps.

Learn more in our comprehensive RxDx OBG Course

Indications

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Fetal Distress

Non-reassuring fetal heart rate

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Maternal Exhaustion

Inability to push effectively

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Prolonged Second Stage

Failure to progress

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Maternal Medical Conditions

Cardiac, respiratory disease

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Fetal Malposition

Occiput posterior position

Contraindications

Absolute Contraindications

✗ Patient refusal
✗ Cephalopelvic disproportion
✗ Gestational age <34 weeks

Relative Contraindications

✗ Unengaged fetal head
✗ Incomplete cervical dilation
✗ Fetal bleeding disorder

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, adequate analgesia, proper positioning, equipment setup, and team briefing.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Ensure adequate analgesia.

Step 2: Assessment

Assess fetal position, station, and maternal pelvis.

⚠️ Common Mistakes to Avoid:

  • Wrong assessment
  • Missed contraindications

💡 Pro Tip:

Confirm fetal position carefully.

Step 3: Cup Application

Apply vacuum cup correctly on fetal scalp.

⚠️ Common Mistakes to Avoid:

  • Wrong placement
  • Incomplete application

💡 Pro Tip:

Place cup on flexion point.

Step 4: Suction Creation

Create adequate suction (0.6-0.8 kg/cm²).

⚠️ Common Mistakes to Avoid:

  • Inadequate suction
  • Excessive suction

💡 Pro Tip:

Use appropriate suction pressure.

Step 5: Traction

Apply gentle traction in correct direction.

⚠️ Common Mistakes to Avoid:

  • Excessive force
  • Wrong direction

💡 Pro Tip:

Use gentle, steady traction.

Step 6: Delivery

Complete delivery of baby.

⚠️ Common Mistakes to Avoid:

  • Rushed delivery
  • Incomplete delivery

💡 Pro Tip:

Complete delivery carefully.

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Post-procedure Care

Post-procedure care involves monitoring for complications, scalp assessment, and patient education.

Complications & Management

Complication Incidence Signs Management Prevention
Scalp trauma 10-20% Scalp bruising, caput Neonatal assessment Gentle technique
Cephalohematoma 5-15% Scalp swelling Observation Proper cup placement
Perineal trauma 10-25% Laceration, bleeding Repair, hemostasis Episiotomy when needed
Failed vacuum 3-8% Cup detachment, no progress Forceps or cesarean Proper assessment

Clinical Pearls

💡

Place cup on flexion point.

🎯

Use appropriate suction pressure.

⚡

Apply gentle, steady traction.

🔍

Monitor for cup detachment.

📊

Limit attempts to 3-4.

🎨

Assess neonatal scalp carefully.

⚠️

Be prepared for alternative delivery.