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The consequences of vacuum delivery for a woman's health. Consequences of vacuum extraction of the fetus. How does vacuum aspiration work?

Vacuum extraction is used when acute shortage oxygen or with weak labor that cannot be corrected medicines(prostaglandins or). To exclude unfavorable, observe following conditions carrying out vacuum extraction of the fetus: the uterine pharynx must be completely open, the child must be alive, his head must be in the birth canal.

Vacuum extraction of the fetus is carried out as follows. A catheter is inserted into the woman in labor. bladder, apply anesthesia, perform an examination of the birth canal. Then he opens the entrance to the vagina with one hand, and with the other hand inserts the cup of the device inside, places it on the baby's head, creates negative pressure in the cup. Then the woman in labor, at the command of the doctor, begins to push, and the doctor at this time must pull out the fetus.

Vacuum delivery is not used if the uterine pharynx is not opened, if it is too high, and if the baby or fetus is premature. Contraindications for vacuum extraction are also: serious condition a woman in labor, which excludes the likelihood of attempts, delivery ahead of time, a discrepancy between the size of the baby's head and the woman's pelvis, extensor presentation of the fetus.

Vaccum extraction is not used if the woman in labor is prohibited from pushing for certain indications.

What can be the consequences of vacuum extraction

Vacuum extraction is not a very effective and traumatic procedure, therefore, in most cases, cesarean is used instead. During vacuum delivery, it can be damaged tender baby... If the procedure is delayed, in order to save the baby's life, it will have to be pulled out with forceps. Other consequences of vacuum extraction are the slipping of the cup of the baby's apparatus, the lack of movement of the baby along the birth canal, and birth trauma to the baby.

During vacuum extraction, the mother's uterus and vagina can be injured.

The consequences of a birth injury can be varied: cerebral hemorrhages, paresis, paralysis, seizures, growth retardation and development of limbs, impairment muscle tone, hydrocephalus, intracranial hypertension, hypertensive syndrome, cranial nerve damage, perinatal encephalopathy(PEP), cerebral paralysis(Cerebral palsy), delay speech development, delay psychomotor development, pneumonia, minimal cerebral dysfunction, urosepsis.

They passed easily and without complications, and the baby was born healthy! But in reality, childbirth happens different situations that cannot be predicted in advance. Sometimes the second stage of labor, which is called pushing, is delayed, and the baby still cannot be born. In some cases, there are signs that the child is beginning to suffer before it is born. In such situations, surgical aids in childbirth can help, one of which is vacuum extraction of the fetus. Does this method have negative consequences for newborns? We fully devote our article today to this topic.

Vacuum extraction of the fetus during labor is called surgery using a special device that helps to remove the baby from the birth canal by his head. This device is called a vacuum extractor. It includes a pressure gauge, an electric pump and a set of applicators (cups) for the fetus's head.

The device itself was developed over 60 years ago. The principle of its operation is as follows: create negative pressure between the baby's head and the cup of the device superimposed on it in order to move the head along the birth canal to the exit.

What are the indications for the operation?

Vacuum extraction during childbirth is rarely performed because it requires strict indications. The following are the most common indications:

  • Weak generic activity in a persistent period (weak attempts), which does not respond to drugs. As a result, the second stage of labor is delayed.
  • The appearance of signs that have begun acute hypoxia(lack of oxygen) baby in labor.

In order to be able to use the vacuum extractor during the strenuous period, it is necessary that the uterine pharynx be completely open, the fetus is alive, and its head is already in the pelvic cavity. In addition, the operation is carried out with the active participation of the mother herself, because she needs to push at the moment when the doctor tightens the baby's head with the help of a vacuum extractor. If a woman cannot push, then only the application of obstetric forceps can be used.

This allowance is not carried out in childbirth for those women who are contraindicated to push (in some cases of severe preeclampsia and a number of diseases). Such expectant mothers are shown planned or emergency cesarean section.

It is also impossible to carry out the operation if there is a discrepancy between the size of the baby's head and the size of the mother's pelvis, in case of premature birth.

Another contraindication for vacuum extraction is wrong position the head of the fetus, including when it is not pressed by the chin to the chest, but is in an extension position.

Some nuances of the operation technique

After the doctors accompanying the woman during childbirth decide that it is necessary to help the baby to be born and use a vacuum extractor for this, it is necessary to conduct a vaginal examination and empty the bladder again. The woman does not need anesthesia, she should feel the attempts well. The only exceptions are those cases when epidural analgesia was performed in advance according to the available indications.

When conducting vacuum extraction, a woman lies on her back with legs wide apart, which are bent at the knees and hip joints, that is, in the same way as with ordinary attempts. The doctor inserts a vacuum-extractor cup into the vagina and fixes it in a certain place on the fetus's head. Then, with the help of an electric pump, negative pressure is created between the baby's head and the cup, the value of the pressure is monitored on the pressure gauge.

As soon as the pressure reaches the desired value, the doctor, holding on to the handle of the cup, pulls the baby's head outward. Mom is pushing at this moment, that is, the synchronization of the actions of both the doctor and the mother is very important. The movement of the doctor's hand should be such that the head moves in the right direction along the bends of the birth canal. In the intervals between contractions, traction (stretching) of the head is not carried out.

After the parietal tubercles are born in the baby, the doctor carefully removes the cup of the apparatus from the head. Further, the woman herself gives birth to the baby's head, the midwife or doctor helps her a little with her hands. The whole procedure is carried out very carefully to minimize the risk. undesirable consequences vacuum extraction.

If during the procedure, the cup slips off the baby's head, then it can be applied again, but only once. If the situation repeats or if there is no effect from the procedure, you have to resort to the imposition of forceps. Fortunately, this does not happen often.

It was laid down by nature so that a child should be born on his own, without any benefits and outside help. Both doctors and mothers unwittingly wonder if vacuum extraction has a negative influence on the health of the baby? Yes, adverse consequences there are procedures, but it is worth considering the following: firstly, the procedure is carried out only according to strict indications, and secondly, the risk of an unfavorable outcome of childbirth without using vacuum extraction is sometimes much higher (when it comes to acute fetal hypoxia in the second stage of labor).

We will talk with a neonatologist about whether babies who have undergone vacuum extraction during childbirth are born healthy.

Expert commentary

- Ekaterina Vladimirovna, please tell us if any Negative influence on the health of children vacuum extraction during childbirth? After all, initially, doctors go to this operation in order to save the child's life and preserve his health?

In fact, the operation of vacuum extraction of the fetus in childbirth is used in situations where there is a threat to the life and health of the baby, it is too late to perform a cesarean section, and the moment when obstetric forceps can be applied has not yet come. The health status of children who were born by caesarean section, or who were born with forceps, is well studied. But on the course of the neonatal period of babies who underwent vacuum extraction in childbirth, there is very little data in the literature. There is also no information about the future health of these children (neurological outcome).

Six years ago, my colleagues and I analyzed the birth histories of children who had undergone vacuum extraction during labor, and also followed the “further fate” of about a third of the babies examined at the first stage. The work was carried out on the basis of one of the maternity hospitals in the city of Arkhangelsk. At the first stage of work (maternity hospital), 100 histories of the development of newborns were studied. At the second stage (polyclinic), we were able to trace in detail the state of health of 35 babies up to one year of age.

- What can you say about the health of babies at the stage maternity hospital based on the results of your work?

We received the following data:

Every second child who has undergone vacuum extraction during childbirth requires primary or resuscitation care immediately after birth. However, this cannot be said to be the result of the vacuum extraction procedure itself. Nevertheless, the intervention was carried out to a greater extent in those cases when there were signs of fetal hypoxia during childbirth, that is, the child had already suffered.

Various disorders of muscle tone and reflexes are the main neurological pathology of children, noted at the stage of the maternity hospital. So, at birth, about 90% of babies have muscle tone disorders, and 21% of children have reflex disorders. By discharge, these numbers are becoming more positive: 75% and 5%, respectively.

More than half of newborns after vacuum extraction have hemorrhages of various localization and varying degrees severity. These include hemorrhage under the periosteum of the bones of the skull (cephalohematoma), hemorrhages under the muscular helmet of the head, into the scalp and into the skin of the face.

- Ekaterina Vladimirovna, are there many children who underwent vacuum extraction in childbirth, are discharged home?

Most of the children are discharged home from the maternity hospital, but 16% of the children demanded transfer to the neonatal pathology unit, 2% of the babies to the neonatal intensive care unit for further examination and treatment. Only a tenth of the babies discharged home have no diagnosis at discharge, that is, they went home practically healthy.

- Is the state of health of babies improving by the end of the first year of life according to your work?

Unfortunately, we were not able to track all the children on different reasons... Out of 100 children of the first stage, only 35 turned out to be at the second stage of work. Here's what we got: by their first birthday, most of the children who underwent vacuum extraction during childbirth are removed from the dispensary registration of a neurologist and orthopedist. But three children from 35 to one year old nevertheless, they were registered with a neurologist with rather serious diagnoses.

- Thank you for the conversation!

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Vacuum fetal extraction is the extraction of the baby 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 cup is placed on the head of the fetus and a negative pressure is gradually created in the apparatus, then, during the contraction, movements are made that contribute to the extraction of the fetus, and the woman in labor pushes at the same time.

Pain relief is usually not applied as needed Active participation women in labor, 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 in primipara.

Vacuum extraction is applied under certain conditions: full opening cervix, absence fetal membranes, correct presentation fetus.

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

Indications for vacuum extraction of the fetus.

Vacuum extraction of the fetus 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.

Fetal hypoxia if it is not possible to perform an emergency caesarean section.

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

Preeclampsia of medium and mild at the mother.

The mother has extragenital pathology(cardiovascular, pulmonary and other diseases), which requires the elimination or reduction of the period of pushing.

There is a vacuum extraction and contraindications.

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

Inconsistency between the size of the pelvis and the size of the fetal head.

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

Vacuum extraction of the fetus: implications for mother and child.

With vacuum extraction of the fetus less often than with the application of forceps, there are injuries in the mother, but more often in the child. The most frequent consequences extraction vacuum for the mother is a rupture of the birth canal. Also, the use of a vacuum increases the risk of postpartum infectious complications.

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

Intracranial hemorrhage is a serious consequence of vacuum extraction, but this is extremely rare. More high probability hemorrhages in premature babies, therefore, they try not to apply a vacuum in preterm labor.

After a vacuum, newborns often develop head swelling that disappears within 48 hours and does not cause any harm.

Trauma such as cephalohematoma is often observed, 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 it is required medical intervention(puncture).

Most of the damage in a child occurs with repeated slipping of the cup of the apparatus from the fetal head, prolonged attempts to remove it, or the use of excessive force during the procedure.

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

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

Natural childbirth for a woman is a process that takes a lot of energy, but as a result, a baby is born. For this, you can endure any pain and anguish. Childbirth does not always go smoothly, there are situations when you cannot do without surgical manipulations. Among them is vacuum extraction of the fetus. The process is quite complicated. The doctor must have great professionalism to carry out the manipulation without consequences for the mother and child. When can a vacuum be used? What are the consequences of this method of delivery? These questions are answered in the article.

Understanding the terminology

So what is fetal vacuum extraction? This is a delivery using a special device that captures the baby's head and thereby helps him pass through the birth canal. There are several types of them:

    Malstrom's apparatus. It consists of metal cups, with a diameter of 15 to 80 millimeters. It is used quite rarely, the device is dangerous for the baby. Damage to the scalp and skull bones often occurs.

    More modern apparatus - Chachaeva and Vashakidze. In this case, the vacuum is presented in the form of a rubber cap that grips the baby's head.

    Each maternity ward has similar devices. They are used extremely rarely, as there is Great chance harm the child. This can manifest itself in the form of neurological problems, damage to integrity skin and much more.

    A modern vacuum apparatus consists of a pear, which is made of silicone, it is no larger in size chicken eggs... Through the vagina, the doctor places it to the baby's head, after which a special hose is connected, connected to the pump. Only an experienced doctor needs to carry out the operation in order to minimize the risks for the child. You can use the device only during contractions, and during the break it is better to remove the device so that bedsores do not appear on the baby's head. For this, a special valve is built into it, which freely disconnects the vacuum.

    If there are complications during childbirth, the doctor needs to act immediately to save the mother and the baby. If the baby does not move along the birth canal, the use of a vacuum apparatus is justified.

    Preparing for surgery

    Many women in labor are worried about complications and unforeseen situations. Even the best and most qualified obstetricians and gynecologists cannot promise that the process will take place smooth. Sometimes situations occur that are beyond the control of the woman or the doctors. If contractions or attempts suddenly stop, and the baby is already in the birth canal, specialists need to apply a vacuum. Such a delivery operation requires almost no special training for woman. Doctors and nurses will do everything for her.

    Firstly, a catheter will be placed, after which anesthesia will take place (novocaine injection or Secondly, the doctor will need to know the exact location of the fetus. It can be determined using an ultrasound machine or manually. After all the manipulations, when the device is attached to the baby's head, the woman in labor it is necessary to follow all the recommendations of the doctor.

    Indications for use

    Each maternity ward is equipped with everything necessary to help women in a difficult process. No exception and vacuum apparatus... V last years they are used quite rarely, but still there are situations when it is almost impossible to do without them:

    1. Abruptly ended contractions and attempts that are not caused by oxytocin.

      Endometritis.

    Obstetric forceps are not entirely safe. The doctor performing the operation must have tremendous professional skills and have experience in such manipulations.

    Which is safer: forceps or vacuum?

    On the forums, you can often see the question: "What do doctors most often use in case of complications in childbirth?" There is no definite answer to it. It all depends on the situation and the experience of the doctor. So, the use of a vacuum is less traumatic for a woman. Much less often, vaginal rupture occurs. As for anesthesia, you will need it anyway. As a rule, novocaine is used. unacceptable, since the woman must be conscious.

    Another advantage of the vacuum is that it is safer for the child. Forceps can damage the skin and cause significant harm to your baby. There are times when doctors use several methods for delivery. V in this case the scheme should be as follows: the imposition of forceps, and then vacuum. If that doesn't work, doctors need to do an emergency caesarean section.

    Vacuum extraction of the fetus is used only in extreme cases. Unfortunately, the statistics of the use of this device are not very encouraging. The risks of injuring a child are quite high.

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

It has been proven that, compared to forceps, vacuum extraction is easier, requires less pain relief, 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, constant development of new devices, lack of reliable statistical data and full clinical studies.

Preparing for the procedure

Vacuum extraction of the fetus can only be performed by a physician experienced in such manipulation. It is necessary for the woman to 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 versus caesarean section;
  • answer all your questions.

If the procedure becomes necessary only during childbirth, such explanations are provided 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 were opened, the water departed;
  • the head is inserted into the small pelvis;
  • the neck is completely expanded;
  • the bladder is empty or catheterized.

If it is not known whether the head, buttocks, or legs, in addition to obstetric research it is easy to find out with the help of 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 peculiarities of attaching the vacuum extractor cup.

The procedure can be performed without anesthesia, but epidural anesthesia is most often used (as we do).

Indications

Manipulation can only be performed if there are certain indications, in other cases a caesarean section is preferable. Absolute conditions for its application does not exist. The most frequent readings the following states:

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

All of these indications are relative, and a caesarean section can be performed under the same conditions. Therefore, the decision on the mode of delivery should be made 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 fetal movement through the birth canal for 4 hours using epidural anesthesia and 3 hours without it. In women who have given birth, this time is reduced by 2 hours.

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

Carrying out the procedure

In women with indicators approaching those indicated above, active observation is used. If generic process still goes, and the child's heartbeat does not suffer, oxytocin stimulation can be used. With exhaustion of labor forces or violations of the child's condition, vacuum extraction or a cesarean section is indicated.

Acute fetal hypoxia

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

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

Diseases of the mother

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

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

Contraindications

Absolute contraindications:

  • the doctor's lack of experience;
  • impossibility of correct application of the vacuum extractor cup;
  • lack of standard readings;
  • unknown position or presentation;
  • suspicion of a discrepancy between the size of the mother's pelvis and the fetal head;
  • breech, facial or frontal presentation;
  • suspicion of blood disease or bone demineralization in a child.

Relative contraindications:

  • insufficient head drooping;
  • 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 depends on the exact position of the cup over the center of the presenting part, the anatomy of the pelvis, traction technique and the design of the apparatus. After obtaining informed consent, the doctor inserts the cup into the birth canal and places it correctly. The center should fall on an imaginary point above middle line sagittal (median) cranial suture, approximately 6 cm from the anterior fontanelle and 3 cm from the posterior. The edges of the cup should be 3 cm from the anterior fontanelle and at the edge of the posterior fontanelle. A low pressure (100-150 mm Hg) is then created to check if maternal tissue has entered the bowl.

Kiwi vacuum extractor

After checking the placement of the cup, the doctor creates a full vacuum (450-600 mmHg) and makes traction (movement), simultaneously with the contractions of the uterus. The direction of traction changes as the head of the fetus passes the birth canal. Attempt to stretch without attendants uterine contractions most often it ends unsuccessfully.

During the period of relaxation 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 other hand in the vagina, placing 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 disconnection 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. Preventive use antibiotics are also not required.

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

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

Consequences for mother and child

Complications of fetal vacuum extraction cannot be considered in isolation, they must be compared in frequency and severity with other methods (forceps, caesarean section). Most often observed birth injury, and most severe complication- intracranial hemorrhage. This condition occurs extremely rarely, but in 20% of cases it is accompanied by lethal 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;
  • fracture of the bones of the skull.

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

The consequences for the mother are less severe than with forceps or a caesarean section. However, sometimes it does occur, the frequency of which is 5-30%, especially with trauma in previous births or episiotomy performed before vacuum extraction.

Conclusion

Fruit vacuum extraction - effective and safe method assistance to women in childbirth, if used by an experienced doctor. After the birth of a child, with the help of such manipulation, it is carried out enhanced surveillance so as not to miss signs of intracranial hemorrhage. For mother the main danger an injury to the perineum becomes, which can further lead to dysfunction of the anal sphincter.

To reduce the risk of injury, it is necessary to reduce the number of stretches up to 3-4 times, the number of accidental disconnections of the cups up to 2-3 times, total time procedures - up to 20 minutes. Not recommended after unsuccessful use use obstetric forceps with a vacuum extractor, in this case a cesarean section is preferable. Finally, for any obstacles or difficulties, such manipulation must be abandoned.