Vacuum Extraction (Ventouse)

Vacuum Extraction (Ventouse)
Definition: A vacuum extraction also called vacuum-assisted delivery is a procedure sometimes done
during the course of vaginal childbirth. During a vacuum-assisted vaginal delivery, a health care provider
Will put a disk-shaped cup pressed against the fetal scalp, over the posterior fontanelle. When vacuum
pressure is applied, air beneath the cup is suctioned out and the cup then adheres so tightly to the fetal
scalp that traction on the cord leading to the cup extracts the fetus. This is typically done during a
contraction while the mother pushes. Your health care provider might recommend vacuum extraction
during the second stage of labor when you're pushing, if labor isn't progressing or if the baby's health
depends on an immediate delivery.
Signs and symptoms of a needed vacuum delivery:
1. Prolonged second stage of labor
An extended second stage of labor is a relative, but not absolute, indication for an instrumental delivery.
For nulliparous women, a protracted second stage can be defined as no progress (descent, rotation) after
about four hours with epidural anesthesia and about three hours without epidural anesthesia. For
multiparous women, a protracted second stage can be defined as no progress (descent, rotation) after
about two hours with epidural anesthesia and about one hour without epidural anesthesia.
2. Suspicion of immediate or potential fetal compromise
The suspicion of immediate or potential fetal compromise (e.g., abruption, acutely non-reassuring
electronic fetal monitoring tracing) is a classic indication for either an operative or a cesarean delivery.
3. Maternal medical disorders
Certain maternal disorders preclude the ability of the mother to safely Valsalva. Typically, cardiac,
cerebrovascular or pulmonary disorders are included. There are other maternal disorders (neuromuscular,
spinal cord injury, etc) that make pushing ineffective. Extremely high blood pressure certain heart
conditions, such as pulmonary hypertension or Eisenmenger’s syndrome a history of aneurysm or stroke
neuromuscular disorders.
4. Maternal Exhaustion.
The mother is too tired to bear down that is why she is needed to be assisted with the help of suction cups
to deliver the baby.
Procedure:
Before a vacuum extraction is done, you’ll usually be given an epidural (if you haven’t had it already) or
numbing medication to block the pain. There’s also a chance that your doctor may need to perform an
episiotomy — an incision of the tissue between the vagina and the anus — to enlarge the vaginal opening
for the placement of the vacuum.
Then, the doctor will perform the following steps:
Between contractions, a doctor will place the vacuum extraction's cup onto your baby's head.
During contractions, the doctor will use the vacuum pump to create suction, which will help guide the
baby through the birth canal and prevent the baby's head from moving back up the birth canal in between
contractions.
After the baby's head is delivered, your doctor will remove the cup and you can push the rest of your
baby's body out.
Risk of performing vacuum extraction:
The baby:
1. Superficial scalp wounds
Vacuum-assisted deliveries may also cause small breaks in the skin or cuts on the scalp. These injuries
are more likely to occur during difficult deliveries that are prolonged or that involve multiple detachments
of the suction cup. In most cases, the wounds are superficial and heal quickly without leaving any lasting
marks.
2. Hematoma
A hematoma is the formation of blood under the skin. It usually happens when a vein or artery becomes
injured, causing blood to seep out of the blood vessel and into the surrounding tissues.
a. Cephalohematoma refers to bleeding that’s confined to the space under the fibrous covering of
the skull bone. This type of hematoma rarely leads to complications, but it typically takes one to
two weeks for the collection of blood to go away. A child with cephalohematoma usually doesn’t
need extensive treatment or surgery.
b. Subgaleal hematoma, however, is a more serious form of bleeding. It occurs when blood
accumulates just under the scalp. Since the subgaleal space is large, a significant amount of blood
can be lost in this area of the skull. This is why subgaleal hematoma is considered to be the most
dangerous complication of vacuum-assisted delivery.
3. Intracranial hemorrhage
Intracranial hemorrhage, or bleeding inside the skull, is a very rare yet serious complication of vacuum-
assisted delivery. The suction applied to your baby’s head may damage or injure the veins, causing
bleeding in your baby’s skull. Although intracranial hemorrhage is rare, when it does occur, it can lead to
loss of memory, speech, or movement in the affected area.
4. Skull fracture
5. Neonatal jaundice
When vacuum extractors are used to deliver your baby, a very large bruise may form over their scalp or
head. Bruising occurs when there’s damage to the blood vessels, causing blood to leak out and form a
black-and-blue mark. The body eventually absorbs the blood from the bruise. This blood breaks down and
produces more bilirubin, which is normally removed from the blood by the liver. However, your baby’s
liver may be underdeveloped and unable to remove bilirubin efficiently. When there’s excess bilirubin in
the blood, it can settle in the skin. This causes a yellowish discoloration of the skin and eyes.
6. Retinal hemorrhage
Retinal hemorrhage, or bleeding in the back of the eyes, is relatively common in newborns. The condition
usually isn’t serious and goes away quickly without causing complications. The exact cause of retinal
bleeding isn’t known. However, it might be a result of the pressure placed on your baby’s head as it
passes through the birth canal.
The mother:
1. Pain in the perineum
2. Tears in the vagina or the perineum
3. Short-term difficulty urinating
4. Short- or long-term incontinence
5. An episiotomy to enlarge the vaginal opening to place the vacuum on your baby’s head
Nursing Care:
1. Assure equipment for neonatal resuscitation is available and in working order.
2. Assure that the provider’s preferred instrument is available.
3. Prepare for possible episiotomy
4. Monitor FHR continuously
5. After birth, monitor mother and infant for trauma
6. Apply ice to perineum afterwards
7. Monitor infant for facial symmetry, skin breaks, neurologic abnormalities, and arm movements.
8. Provide emotional support to the mother.

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