Preparations 

Vacuum extraction of the fetus: consequences, indications

What is vacuum fetal extraction?

Vacuum birth, what is it?

In the process of weak labor activity, when the efforts of the woman in labor do not bring the desired result, due to weak contractions and attempts, they resort to the use of a special vacuum apparatus. Why is it necessary? For various reasons (we will consider them a little later), urgent help is required for the woman in labor to push the baby out. And the vacuum extractor just does help to pull the baby out of the birth canal.

The device operates as follows: a vacuum cup is inserted into the vagina and leaned against the head, then pressure is created, which pulls the bladder out. However, the consequences can be very unpleasant and sad for the child, therefore, such a procedure is resorted to in extreme cases, and then only doctors with great experience behind them. Often, the vacuum aspiration method is also used for missed pregnancy or spontaneous miscarriage, in order to extract the fetal egg.

Vacuum delivery indications

Agree, if the risks of complications are so high, then the use of a vacuum should be justified. What indications make doctors and obstetricians resort to such a serious method?

  • acute oxygen starvation of the crumbs;
  • a sharp decrease in heart rate in a baby;
  • endometritis;
  • weak labor activity that cannot be stimulated by medication (for example, with the help of oxytocin).

If a woman cannot strain and push hard for any reason (problems of the cardiovascular system, increased eye pressure, etc.), then it is indicated. That is why it is so important to warn your gynecologist leading a pregnancy in advance about various features and problems of your body, as well as visit narrow specialists to resolve the issue of the method of delivery. If the doctor insists on a caesarean section, there is no need to refuse, because no one is offered to go under the knife just like that. This means that due to the problems of your body, a difficult course of childbirth is possible, and therefore you will have to resort to various kinds of stimulation and manual assistance, in particular, to the vacuum method of extraction, which is much worse than a cesarean.

Pros and Cons of Vacuum Extraction

What conditions allow the baby to be pulled out with a vacuum?

  • live baby;
  • term pregnancy;
  • the size of the head does not exceed the size of the pelvis;
  • the head of the fetus descended into the small pelvis;
  • the woman is conscious, her mind is not clouded, she is able to follow the doctor's commands.

Only when absolutely all conditions are met is it possible to use such a radical method of pulling crumbs. If at least one item does not correspond to your situation, then it is FORBIDDEN to use vacuum extraction!

What are the contraindications for this procedure?

    • inability to push;
    • early childbirth;
    • the child goes not with the head, but with the buttocks, or an incorrect head presentation;
    • the size of the head does not correspond to the size of the pelvis;
    • insufficient disclosure (less than 10 cm);
    • stillbirth.

Consequences

Often, during this mini-operation, the cup slips off the baby's head, which is fraught with injury to the tiny head and the development of complications. However, complications can arise even with a perfectly performed procedure!

What are the consequences for the child when using such an unsafe method of delivery, even if the doctors themselves try to resort to this procedure in extremely rare cases, in the absence of the possibility of another, safer way to stretch the baby?

The consequences can be of moderate severity:

      • damage to the scalp;
      • jaundice;
      • hemorrhage of the vessels of the eyes.

And extremely heavy:

      • cephalohematoma;
      • intracranial pressure;
      • facial deformities;
      • epilepsy;
      • trauma to the brain or spinal cord;
      • various neurological diseases;
      • convulsions;
      • delay in emotional and / or psychological development;
      • various damage to the nervous system;

Very often, after vacuum extraction, a hematoma occurs in the back of the head of the baby, which itself resolves and does not cause any harm to the development and life of the crumbs. But this is the most positive scenario for the development of events. Statistics show that complications occur in about half of the cases. Therefore, such interference in the birth process, even if with a good purpose, should be very well weighed.

Consequences for mother:

      • various kinds of breaks (birth canal, perineum);
      • the development of infections;
      • increase in the period of postpartum recovery;
      • deformity of the external genitalia.

Many women note after this method of delivery.

Dear readers, everyone wants every child in this world to be healthy and have the opportunity to enjoy life, right? That is why it is necessary to carefully approach the issues of planning and carrying a pregnancy, as well as delivery. Therefore, if you are aware of your health problems that may interfere with the normal process of childbirth, then it is necessary to discuss this with your doctor in advance.

I really hope that each of you will be a happy mother of a healthy and cheeky toddler. Health to you and your crumbs! All the best! See you!

There is an opinion that its imposition requires less experience and skills. This is partly true, but there is a potential danger in this statement. The “put the extractor and turn on” approach is widespread, its proponents believe that the extraction of the fetus is an easy and safe method for weak labor and less dangerous than the application of obstetric forceps. The preoperative preparation and the conditions required for both surgical interventions are the same.

Compared with the imposition of obstetric forceps, the risk of trauma to the mother's vagina and perineum is lower with vacuum extraction. In addition, for vacuum extraction there is no need for such anesthesia as for the application of obstetric forceps (epidural or spinal anesthesia), pudendal blockade is sufficient.

There are many different types of vacuum extractors, but they are all divided into two fundamentally different groups - with soft and hard cups. Initially, rigid cups were made of metal (the Malmström vacuum extractor and Byrd's modification). A little later, hard plastic cups began to be produced. In the 1970s Softer cups have been developed to prevent trauma to the fetal skull that is common with hard cups. The first of these were Kobayashi's silicone cups. Since then, many types of elastic cups have been developed. With their use, the percentage of superficial damage to the skull is usually lower, but the percentage of successfully completed births with hard cups is higher. The principles of imposing both types of cups are the same.

Flexion and vacuum extraction of the fetus

“Performing some of the actions in vacuum extraction requires a lot of force. This is due to the fact that the direction of application of efforts is incorrect, since the head is not sufficiently bent and, at the beginning of traction, passes through the pubic symphysis, instead of passing under the pubic arch.

The main and most important point is to determine the flexion point, which is located 3 cm anterior to the small fontanel. If traction is started by applying a vacuum extractor to this point, the head bends and passes through the birth canal with its smallest size - small oblique (9.5 cm). Most vacuum extractors have a cup diameter of 5 or 6 cm. Thus, if the cup is placed so that its edge is located at the edge of the small fontanel, then its middle is exactly above the flexion point. Another way to determine the correct imposition of the calyx is to measure the distance between its front edge and the large fontanel. The distance from the edge of the large fontanel to the point of flexion is about 6 cm. So, if the cup of the vacuum extractor is applied correctly, the distance between its front edge and the large fontanelle should be approximately 3 cm (the width of two fingers). In addition, when performing flexion, asynclitism should be avoided, the presence of which increases the size of the head, with which it passes through the birth canal. If the sagittal suture does not pass through the center of the cup when the vacuum extractor cup is applied, traction in this position will result in asynclic insertion. There are four possible options for applying the vacuum extractor cup:

  • medial flexion - the head passes through the birth canal in the smallest sizes (small oblique and biparietal);
  • medial extensor - the head passes through the birth canal with a straight size;
  • paramedial flexion - the head passes through the birth canal with a large paramedial size;
  • paramedial extensor, in which the worst position is created - a combination of direct and paramedial sizes.

The percentage of trauma to the fetal head is minimal with the correct application of the vacuum extractor cup.

The correct location of the cup is the median location relative to the sagittal suture above the flexion point. After applying the cup, create a vacuum of about 0.2 kg / cm 2, then run your index finger along the edge of the cup, checking if the mother's tissues are trapped. If everything is done correctly, you need to create a vacuum of up to 0.8 kg / cm2. After all checks and the creation of the necessary pressure, the start of traction should not be delayed for more than 1-2 minutes, because. a tumor will form on the head of the fetus.

Both in hard and soft cups, the edge is bent inward, so the diameter along the outer edge is larger than along the inner one, which creates the prerequisites for the occurrence of a head tumor. The difference in pressure between the outside and inside of the cup prevents it from slipping and also causes the effective cup diameter to increase from 5 to 6 cm.

The traction force required to remove the cup depends on its diameter and the degree of vacuum. It is possible to calculate the traction force, only it must be taken into account that the force should be applied perpendicular to the plane of the cup. The traction force is the maximum possible force relative to the vacuum created inside the cup, provided that the traction is at right angles to its surface. There is also an additional traction force of the tissues captured by the vacuum extractor cup. Some use a maximum pressure of 760 mmHg. Art., because this level is close to full vacuum. When calculating the force, one proceeds from perpendicular tractions and excludes the effect of displacement. There is a simple rule that allows you to fulfill this condition - the direction of the thrust should not go beyond the area of ​​the projection of the circumference of the vacuum extractor cup. Tractions carried out at a certain angle to the cup surface are corrected according to the force vector.

In practice, traction should be carried out simultaneously with the contractions and attempts of the patient. Traction is performed with one hand, the index and middle fingers of which lie on the crossbar of the extractor, the thumb of the other hand is placed on the outer surface of the cup, and the index finger is placed on the skull bones next to the cup. In this way, it is possible to control the development of the clinical situation, which J. Byrd called "negative traction": the soft tissues of the fetal head move, while the bones of the skull remain in the same place.

Repeated ineffective traction leads to the fact that a pressure drop is created, resulting in an increased risk of intracranial hematoma and hematoma of the soft tissues of the head. The thumb can control the slippage of the calyx, and the index finger can control the movement of the skull bones relative to the birth canal as a result of traction. Thus, vacuum extraction is carried out with both hands - with the thumb of the left hand, the cup is pressed against the surface of the skull, the lowering of the head is controlled with the index finger, while the right hand is used for traction perpendicular to the plane of the cup. These movements should be practiced on a mannequin.

Some vacuum extractors, in particular the widely used OmniCup, have a traction force indicator. According to clinical studies, most births were carried out using a traction force of < 9 kg, but sometimes up to * 14 kg is required.

Rigid cups have the advantage of being less likely to slip off and can be used in posterior occiput presentation or head extension and sagittal suture transverse. The disadvantages of soft cups are, firstly, the presence of a central rod that prevents the cup from being placed on the flexion point in most extensor presentations; secondly, the process of controlling vacuum extraction with the fingers of the left hand is more difficult, compared to hard cups. However, in vacuum extraction with a soft cup, you can place the fingers of your left hand around the periphery of the cup and control the process according to the same principles.

Do not attempt to rotate the fetal head with traction in an oblique direction. With the correct application of the cup during traction, an independent rotation of the fetal head occurs.

If the fetal head descended to the perineum by vacuum extraction and then traction became less effective, the space between the fetal head and sacrum should be palpated. A. Vacca described cases of the fetus's pen being between its head and the mother's sacrum and called this condition "pen wedging", which can lengthen the time of birth of the head. In this situation, a hand should be inserted into this space and, clasping the fetal wrist, facilitate the birth of the back handle.

If the cup slips during vacuum extraction, the situation should be carefully assessed. If vacuum extraction of the fetus is still possible and necessary, the cup is applied again and traction is resumed. If rotation has occurred and the head has fallen to the level of the perineum, childbirth can be completed by applying obstetric forceps. Such a decision requires careful evaluation, as the risk of fetal injury is very high.

Vacuum extraction is conditionally divided into two phases. The descent phase lasts from cup placement until the glans descends to the pelvic floor and the vacuum extractor cup is visible at the entrance to the vagina. The ejection phase lasts from the moment when the calyx is fully visible at the entrance to the vagina, until the birth of the head.

Traction during one contraction is considered as one sip. It is to be expected that after three pulls, the fetal head will be born or at least descend to the point where the calyx is fully visible, so vaginal delivery is indeed possible and safe. Sometimes two to four tractions are needed for gentle delivery of the head. Therefore, three pulls during three contractions should be enough to rotate and lower the head, then several more pulls are needed for a safe atraumatic birth of the head. Thus, in the vast majority of cases, 20 minutes pass from the application of the cup to the birth of the head.

After the birth of the head, the pressure in the cup equalizes, and it is removed. All children born by vacuum extraction should be suspected of having a subgaleal hematoma and examined after birth.

In the postpartum period, the consequences and possible complications after childbirth should be explained to the patient by applying obstetric forceps or a vacuum extractor. You also need to tell her that with a probability of more than 80% in subsequent births, operative benefits will not be needed.

Vacuum extraction of the fetus is the extraction of the child from the birth canal using a vacuum apparatus. This procedure is used if the second stage of labor is delayed, the child does not move through the birth canal or is under stress.

The vacuum apparatus consists of cups of different diameters and a pump (electric or manual). The first vacuum devices were with metal cups, now they mainly use plastic or silicone, which are less traumatic for the fetus.

The calyx is placed on the fetal head and negative pressure is gradually created in the apparatus, then during the contraction movements are made to help the extraction of the fetus, while the woman in labor is straining.

Anesthesia is usually not used, since the active participation of the mother is necessary, but at the request of the mother, local anesthesia can be performed. Episiotomy (dissection of the perineum) with vacuum extraction is performed infrequently and mainly by primiparas.

Vacuum extraction is used under certain conditions: full opening of the cervix, absence of membranes, correct presentation of the fetus.

A similar vacuum extraction is the procedure for applying obstetric forceps. In principle, these interventions are interchangeable, but the vacuum is used more often, since not all doctors have the skills to use forceps. Cm." " ".

Indications for vacuum extraction of the fetus.

Vacuum fetal extraction is mainly used when it is necessary to urgently remove the baby. There are the following indications for vacuum extraction of the fetus.

Weakness of labor activity.

Fetal hypoxia, if an emergency caesarean section is not possible.

Endometritis in childbirth is an infection of the birth canal, accompanied by fever.

Preeclampsia of moderate and mild degree in the mother.

The presence of an extragenital pathology in the mother (cardiovascular, pulmonary and other diseases), which requires the exclusion or reduction of the period of attempts.

There is a vacuum extraction and contraindications.

Extension insertion of the head - frontal, facial, anterior head presentation. To apply the vacuum, the child must be at the entrance to the small pelvis with the back of the head (occipital presentation).

The discrepancy between the size of the pelvis and the size of the fetal head.

Complications of pregnancy, requiring the complete exclusion of attempts. During vacuum extraction, the woman in labor must push, so when the attempts are completely turned off, forceps are used.

Vacuum fetal extraction: implications for mother and child.

With vacuum extraction of the fetus, less often than with the application of forceps, there are injuries to the mother, but injuries to the child occur more often. The most common consequences of vacuum extraction for the mother are ruptures of the birth canal. Also, the use of vacuum increases the risk of postpartum infectious complications.

The consequences of vacuum extraction of the fetus for a child can be damage to the scalp, difficult birth of the shoulders, hemorrhages in the eyes, hyperbilirubinemia (increased bilirubin or jaundice).

A serious consequence of vacuum extraction is intracranial hemorrhage, but it is extremely rare. A higher likelihood of hemorrhage in premature babies, so they try not to use a vacuum in preterm birth.

After a vacuum, newborns often develop swelling on the head, which disappears within 48 hours and does no harm.

Often there is such an injury as cephalohematoma, in which a subcutaneous cavity filled with blood forms in the damaged area on the head. Small cephalohematomas go away on their own, in some cases medical intervention (puncture) is required.

Most of the damage in the child occurs when the cup of the device repeatedly slips off the fetal head, prolonged attempts to extract or apply excessive force during the procedure.

As for the long-term consequences, such as cerebral palsy, epilepsy, psychomotor retardation, the studies have not proven their connection with instrumental methods of delivery (vacuum, forceps). These diseases are more associated with fetal hypoxia and some pregnancy complications.

In principle, vacuum extraction of the fetus is safe enough for the mother and child, if carried out according to the indications, taking into account all the conditions and observing the execution technique.

In modern obstetrics, the need to ensure the safety of childbirth is increasing. Previously, obstetric forceps were widely used for this, now they have been replaced by a new procedure. Vacuum extraction of the fetus is a manipulation using a low-pressure (“suction”) device that is applied to the presenting part during childbirth. Its use helps with the development of weakness of the birth forces, prolonged labor and other obstetric pathologies, when the child cannot be born on his own.

It has been proven that, compared with obstetric forceps, vacuum extraction is easier, requires less anesthesia, is less traumatic for mother and child, and is safer. However, the use of this procedure is limited due to the growing number of indications for caesarean section, the constant development of new devices, the lack of reliable statistics and full-fledged clinical studies.

Preparation for the procedure

Vacuum extraction of the fetus can only be performed by a doctor experienced in such manipulation. The woman must sign a voluntary informed consent. If the intervention is planned in advance, the doctor should:

  • explain the need for the procedure;
  • discuss with the patient the risks and benefits of this method compared to caesarean section;
  • answer all questions.

If the procedure becomes necessary only during childbirth, such explanations are given in an abbreviated form. Therefore, if it is possible to use manipulation, it is better to first familiarize yourself with its features.

  • the fetal membranes opened, the waters receded;
  • the head is inserted into the small pelvis;
  • the neck is completely dilated;
  • the bladder is emptied or catheterized.

If it is not known whether the head, buttocks or legs are present, in addition to obstetric research, this is easy to find out using ultrasound. In this case, the sensor is placed in the vagina or on the perineum and directly during the first stage of labor makes it possible to quickly and safely determine the presenting part, as well as to determine the features of attaching the vacuum extractor cup.

The procedure can be performed without anesthesia, however, epidural anesthesia is most often used (how it is performed, we).

Indications

Manipulation can be performed only if there are certain indications, in other cases, a caesarean section is preferable. There are no absolute conditions for its application. The most common indications are the following conditions:

  • protracted;
  • acute fetal hypoxia;
  • the need to shorten the second stage of labor to preserve the health of the mother.

All these indications are relative, and under the same conditions, a caesarean section can be performed. Therefore, the decision on the method of delivery should be made by an experienced doctor.

Prolonged second stage of labor

In this case, vacuum extraction is carried out according to relative indications. For nulliparous women, this condition is determined in the absence of the fetus moving through the birth canal for 4 hours with the use of epidural anesthesia and 3 hours without it. In patients giving birth, this time is reduced by 2 hours.

This increases the likelihood of postpartum hemorrhage, chorioamnionitis and perineal injury. The degree of risk of pathology for the newborn is less pronounced.

Carrying out the procedure

In women with rates approaching the above, active surveillance is used. If the birth process is still going on, and the baby's heartbeat does not suffer, stimulation with oxytocin can be used. With the exhaustion of the birth forces or violations of the child's condition, vacuum extraction or a caesarean section is indicated.

Acute fetal hypoxia

This condition requires immediate medical attention (what is the danger of pathology, read). With prolapse of the umbilical cord, persistent slowing of the heartbeat, tight attachment or placenta accreta, this method is prohibited. In these situations, caesarean section is preferable.

However, even in severe cases, everything is decided depending on the specific situation and the experience of the doctor.

Maternal illnesses

Some diseases of a woman require a reduction in the period of attempts. These include heart, lung and brain diseases, pathology of the neuromuscular system, spinal cord, myopia and others.

Vacuum extraction in such cases is performed when the presenting part is lowered so that the procedure can be done quickly and safely.

Contraindications

Absolute contraindications:

  • the lack of experience of the doctor;
  • the inability to properly apply the vacuum extractor cup;
  • lack of standard indications;
  • unknown position or presentation;
  • suspicion of a discrepancy between the size of the pelvis of the mother and the head of the fetus;
  • breech, facial or frontal presentation;
  • suspicion of blood diseases or bone demineralization in a child.

Relative contraindications:

  • insufficient descent of the head;
  • gestational diabetes;
  • large fruit ().

Manipulation

To carry out the manipulation, a special apparatus is used - a vacuum extractor. It is a hard or soft plastic bowl in which a vacuum is created using a pump or a special hose, connected to a pull handle.

The safety and success of the method depend on the exact location of the cup over the center of the presenting part, the anatomy of the pelvis, the traction technique, and the design of the apparatus. After obtaining informed consent, the doctor inserts the cup into the birth canal and sets it correctly. The center should be at an imaginary point above the midline of the sagittal (median) cranial suture, approximately 6 cm from the anterior fontanelle and 3 cm from the posterior. The edges of the cup should be located at a distance of 3 cm from the anterior fontanel and at the edge of the back. Then low pressure (100-150 mmHg) is applied to check if maternal tissue has entered the bowl.

Kiwi Vacuum Extractor

After checking cup placement, the doctor creates a full vacuum (450-600 mmHg) and makes tractions (movements) simultaneously with uterine contractions. The direction of the pull changes as the fetal head passes through the birth canal. An attempt at traction without concomitant uterine contractions most often fails.

During the relaxation period between attempts and contractions, the vacuum can be maintained or reduced to 200 mm Hg. Art. Both of these methods are considered equally safe.

During traction, the doctor places the second hand into the vagina, placing the thumb on the cup, the rest on the head of the fetus. This helps to correctly guide the baby through the birth canal and notice the detachment of the edges of the vacuum extractor in time. All movements should be smooth and not performed "through force", as this increases the risk of damage to the scalp. After removing the head, the pressure in the bowl is normalized and the vacuum extractor is removed. Not recommended. Prophylactic use of antibiotics is also not required.

Usually 2-3 stages of traction are used, and the entire vacuum extraction of the fetus takes about 15 minutes.

If the fetal head does not advance, the doctor's efforts do not bring results, the cup repeatedly slips if it is correctly applied, it is necessary to interrupt the procedure and perform a caesarean section (types, methods of the operation are described).

Consequences for mother and child

Complications of vacuum extraction of the fetus cannot be considered in isolation, they must be compared in frequency and severity with other methods (obstetric forceps, caesarean section). Most often there is a birth injury, and the most severe complication is intracranial hemorrhage. This condition occurs extremely rarely, but in 20% of cases it is accompanied by a fatal outcome. Vacuum extraction can lead to the death of a child in 0.1-3 cases per 1000 procedures.

Possible negative consequences for the child:

  • subcutaneous hemorrhage;
  • damage to the scalp;
  • paralysis of the facial nerve;
  • retinal hemorrhage;
  • skull fracture.

Vacuum extraction of the fetus does not lead to differences between children born in the usual way, or with the use of this manipulation. During the first 18 years of life, they have the same indicators of development, growth, speech, school performance and neurological condition.

The consequences for the mother are less serious than when using forceps or caesarean section. However, sometimes they still occur, the frequency of which is 5-30%, especially with injuries in previous births or an episiotomy performed before vacuum extraction.

Conclusion

Vacuum extraction of the fetus is an effective and safe method of assisting women in childbirth if it is used by an experienced doctor. After the birth of a child with the help of such manipulation, he is closely monitored so as not to miss signs of intracranial hemorrhage. For the mother, the main danger is perineal injury, which in the future can lead to dysfunction of the anal sphincter.

To reduce the risk of injury, it is necessary to reduce the number of tractions to 3-4 times, the number of accidental cup detachments to 2-3 times, the total procedure time to 20 minutes. It is not recommended to use obstetric forceps after unsuccessful use of a vacuum extractor, in this case, a caesarean section is preferable. Finally, with any obstacles or difficulties, it is necessary to abandon such manipulation.

At all times, midwives and obstetricians have been puzzled by the question of how to help a child be born into the world if the birth is difficult, difficult and long. At first, the child was “squeezed out” manually from the womb, then for many decades, the imposition of obstetric forceps on the presenting part was used. Then, in order to reduce the birth trauma of the mother and especially the fetus, they began to use the so-called vacuum during childbirth.

The vacuum extraction method will be discussed in this article.


About method

Since childbirth should be as safe as possible for the woman in labor and the baby, the issues of less trauma from the use of certain methods of childbirth are today considered one of the most important in obstetric practice. Vacuum extraction is a manipulation to extract a baby through the physiological natural birth canal by applying a special device, a vacuum extractor, to its head. By creating a zone of low pressure, the fetus comes out faster and is born.


Different extractors are used - with a metal bowl on the head (Malestrom extractor), with a plastic bowl, which is safer for the fetus, and devices with soft bowls. Any of the listed devices consists of a bowl and a flexible hose connecting the bowl to the extractor pump.


The frequency of using a vacuum during childbirth today is low - no more than 3-5% of all births.

And this is due to the fact that the diagnosis has become more perfect and that there may be problems with the birth of the baby's head, doctors often know in advance. In addition, indications for caesarean section have been expanded, and sometimes it is much safer for a child to have a surgical birth.

Compared to the forceps that were previously used to capture the head, the frequency of trauma to the skull and spine in babies was reduced with vacuum extraction. But until the end, the procedure is not considered safe, and therefore is used mainly only as an emergency.


Indications for use

All issues related to the use of vacuum extraction during labor are indicated by a letter of recommendation from the Ministry of Health of Russia No. 15-4 / 10 / 2-748 of 07/19/12.

The document names the following conditions as direct indications for the use of vacuum:

  • fetal hypoxia and other signs of extreme distress in the child during childbirth, negative symptoms are growing;
  • the state of acute hypoxia of the baby at the moment when his head is already at the exit from the small pelvis;
  • the pushing period of childbirth lasts too long (2 hours for first-time births and an hour for second births);
  • a pre-planned shortening of the second stage of labor, if the woman is contraindicated in attempts to refuse a caesarean section;
  • assistance in removing the head from the incision during caesarean section.

The procedure is carried out only by doctors with similar experience in obstetric care. The woman must give her written consent to such manipulation.



Mandatory conditions for vacuum extraction are the opening of the membranes, the discharge of amniotic fluid and the head must be inserted into the small pelvis. In natural childbirth, the cervix should be as dilated as possible, and the bladder should be empty.

The Ministry of Health quite permits childbirth with the help of a vacuum without anesthesia, but the use of epidural anesthesia is quite often allowed.



When does it not apply?

Childbirth using a vacuum (“kiwi” - after the name of the extraction delivery system) can be dangerous, and therefore the list of contraindications to manipulation is also indicated by the document of the Ministry of Health of Russia.

Vacuum is not applied if:

  • childbirth began prematurely, before 36 weeks of pregnancy;
  • if the estimated fetal weight is less than 2.5 kilograms;
  • the skin of the baby's head is damaged in the place where the extractor cup is to be applied;
  • there is reason to believe that the child has impaired osteogenesis;
  • the child may have genetic pathologies of blood clotting (according to the forecasts of geneticists);
  • the fetal head is too high, and acute hypoxia has already begun - it is better to do a caesarean section;
  • the woman has a clinically narrow pelvis, there is a clear discrepancy between the size of the baby's head and the size of the pelvis;
  • the child is in a facial or pelvic presentation;
  • severe gestosis;
  • previous unsuccessful attempts to apply obstetric forceps.




The extractor is not used if the child has already died, if the cervix has not fully opened.

How is it carried out?

The woman is asked to take a semi-sitting position on the birth table. She should bend her knees, rest her feet on the stops, spread her hips. The disposable extractor bowl is checked for leaks, defects and defects. The doctor clarifies the position of the fetal head. Then a decision is made on the need for an episiotomy - a dissection of the perineum to expand it so that the extractor bowl can pass into the genital tract.

In this case, dissection is not at all considered mandatory, but they try to carry it out in all cases, if you need to enter the extractor quickly, that is, in emergency cases.

The doctor inserts the cup into the vagina with the side that she will have to adjoin the baby's head. Then it is installed on the head so that the swept seam divides it exactly in half.

At the same time, the task of the doctor is to prevent the edge of the cup from being closer than three centimeters from the large fontanel. A vacuum is created in the kiwi system. One hand of the doctor is located at the exit from the small pelvis and helps to "push", the other controls the translational movements.


All traction performed by the doctor using a vacuum must be completely natural, corresponding to the biomechanism of childbirth. It is considered that the procedure was successful if the head began to move forward after the first or second traction, if the baby’s movements are progressive and even, if he made all the necessary turns and extension of the head, as if he was born on his own, without help.

It is considered that the manipulation is successful if the number of tractions was from 2 to 6, the bowl did not slip off the fetal head more than two times, the procedure was completed in 15-20 minutes.


Complications and possible consequences

The birth of a child using a vacuum can be dangerous for him and for the woman in labor if the doctor makes mistakes during traction, as well as during cupping. Most often, the baby has a solid hematoma and abrasions on the soft tissues of the head. It can be not only a banal bruise, but also a cephalohematoma, as well as a subaponeurotic hematoma.

With cephalohematoma, the accumulation of blood is observed between the cranial bone and the periosteum that has exfoliated from it.

If it is small, up to 3 centimeters, then it can resolve on its own in the first weeks of a child's life. In severe cephalohematoma, if it is more than eight centimeters, its opening and pumping of blood from the cavity is indicated. The prognosis is usually quite favorable, such a hematoma does not affect the development of the child, the functions of his body as a whole.

The causes of complications are most often medical errors, the same "human factor" - inaccurate or initially incorrect placement of the bowl on the baby's head, improper removal of the fetus, violation of natural traction, too strong traction, swaying movements during the removal of the child.