II. Preparation
- Preparation for Forceps Assisted Delivery
- Preparation for Vacuum Assisted Delivery
III. Complications
- Maternal: Third and fourth-degree Lacerations
- Spontaneous Vaginal Delivery: 1.7%
- Vacuum extraction: 9.3% risk
- Forceps delivery: 19.2% risk
- Fetal
- Retinal Hemorrhage: Odds Ratio 2.0 higher risk with vacuum more than forceps
- Cephalohematoma: Odds Ratio 2.4 higher risk with vacuum more than forceps
- Subgaleal Hemorrhage
IV. Technique: (Mnemonic - ABCDEFGHIJ)
-
Anesthesia adequate?
- Perineal Local Anesthesia
- Pudendal Block
-
Bladder empty?
- Straight catheterize for urine as needed
- Cervix Completely dilated?
- Determine head position
- Be alert for Shoulder Dystocia
- Equipment ready?
- Confirm that forceps interlock
- Test suction on Vacuum extractor
- Replace Scalp Electrode with External Fetal Monitor
-
Fontanelles ascertained (Position for safety)
- Vacuum
- Vacuum cup centered on the flexion point
- Position vacuum cup anterior to Posterior Fontanelle by 1 cm
- Position vacuum cup behind the Anterior Fontanelle
- Forceps (for trained and experienced forceps users)
- Position
- Forceps positioning
- For
- Forceps Fenestrations (very little of hole palpable)
- Safety
- Sagittal Suture in line with forceps
- Position
- Vacuum
- Gentle steady traction (Pajot's Maneuver)
- Vacuum should only be applied during contraction
- Halt traction between contractions
- Incision or Episiotomy
- When head is being delivered as perineum distends
- Jaw seen
- Remove Forceps or vacuum as jaw is delivered
V. References
- (2005) ALSO Course