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VENTOUSE DELIVERY
Anjana Thomas
Description
 It is an instrumental device designed to assist
delivery by creating a vacuum (negative pressure)
between itself and the fetal scalp.
Definition
 Vaccum extraction also known as ventouse, is a
method to assist delivery of a baby using a vacuum
device. It is a instrumental delivery to assist delivery
by creating a vaccum between it and the fetal scalp.
Equipment Description
 Vacuum extractor is composed of:
 A specially designed cup with a diameter of 3,4,5,6
cm or 30,40,50,60 mm.
 A rubber tube attaching the cup to a glass bottle with
a screw in between to release the negative pressure.
 A manometer fitted in the mouth of the glass bottle to
declare the negative pressure.
 Another rubber tube connecting the bottle to a
suction piece which may be manual or electronic
creating a negative pressure that should not exceed-
0.8 kg per cm2
Part
 Suction cup of variable sizes. It is either metallic or
soft made of silicone .
 Vacuum generator.
 Traction tubing.
Type
 Malmstrom cup
A metal cup to its centre attached a metal chain
passed through the rubber tube. The other end of
the chain is attached to a handle for traction
 Bird’s cup
The suction rubber tube is attached to the periphery
of the cup while the handle of traction is attached by
a separate short metal chain to the centre of the cup.
 Soft cup
It is a bell shaped 6.5 cm diameter soft cup which is
made of a firm but supple silastic material.
 Kiwi cup
It is fexible stem and low profile cup enable
placement over the flexion point of the baby’s head
no matter the fetal head position.
Indications
 Maternal indication
 Maternal distress: exhaustion after a long, painful
labor due to inefficient uterine contraction.
 Prolonged second stage of labor.
 Maternal medical disorders such as heart diseases,
HTN and anemia
 Previous cesarean section or genital prolapse repair.
 Premature separation of placenta.
 Fetal indication
 Deep transverse arrest with adequate pelvis.
 Delay in descend of the high head in case of the
second baby of twins.
 Malposition : occipitolateral and occipito posterior.
 As an alternative to forceps exept in face
presentation and brreech.
 Fetal distress
Contraindication
 Operator inexperience
 Inability to assess fetal position
 Suspicion of cephalopelvic disproportion
 Fetal coagulopathy
 Preterm babies due to risk of fetal intraventricular
hemorrhage.
 Macrosomia >4kg
 Soft tissues obstruction in the pelvis
 Breach presentation and face presentation
Condition to be fulfilled
 There should not be any bony resistance below the
head
 The head of a singleton baby should be engaged
 Cervix should be at least 6 cm dilated.
Prerequisites
 Bladder must be emptied
 Cervix fully dilated
 No evidence of CPD
 Vertex presentation and not above the station of +2
 Membrane must be ruptured
Technique
 Application
 Station of the head and its position is assessed
 Instrument is checked to be in working condition
before application
 Selection of cup is important
 The cup is introduced after retraction of perineum
with two fingers of the other hand
 The centre of the cup should be on the flexion point
of the head, which is a point located on the sagittal
suture, 3cm in front of posterior fontanelle.
 Traction at this point results in maximum
flexion(flexing median application)
 Proper cup placement over flexion point
 Exclude maternal soft tissue entrapment by
palpation
 Vacuum creation by increasing the suction in
increments of 0.2 kg/cm2 every 2 mins until 0.8
kg/cm2
 A check is made using the fingers round the cup to
ensure that no cervical or vaginal tissue is trapped
inside the cup .
 The pressure is gradually raised at the rate of
0.1kg/cm2 per minute until the effective vacuum of
0.8kg/cm2 is achieved in about 10 minutes time
 The scalp is sucked into the cup and an artificial
 Instrument handle is grasped, and initiation of
traction.
 Traction is initiated by using a two-handed
technique, i.e the fingers of one hand are placed
against the suction cup, while the other hand grasps
the handle of the instrument
 Traction must be at right angle to the cup
 Traction directed initially downward then
progressively extended upward as head emerge.
 Traction should be synchronous with the uterine
 Once head is extracted, vacuum pressure is
relieved; cup is removed; vaginal delivery followed.
 The total time from the application until delivery
should not exceed 20 minutes.
 If >20 minutes, the risk of fetal scalp trauma and
intracranial damage increases.
 Many pulls to achieve progress should not be done .
 The operator should be wiling to abandon the
procedure if it does not proceed easily or if the cup
dislodges >3 times
Vacuum application
Complications
 Fetal complications
 Scalp laceration and bruising
 Subglial hematoma, Cephalohematoma
 Intracranial hemorrhage, intraventricular and
cerebral hemorrhages
 Retinal and sub-conjunctival hemorrhages
 Neonatal jaundice
 Clavicular fracture, Shoulder dystocia
 Injury to CVI, CVII nerves, Erb palsy
 Hypoxia, particularly when extraction has taken a
long time and has been difficult
 Fetal death
 Maternal complications
 Soft tissues injuries such as cervical tears, annular
detachment of the cervix, vaginal tears, perineal
lacerations and tears, extension of episiotomy,
vaginal wall and perineal hematomas.
 Traumatic postpartum hemorrhages
 Infection
 Genital prolapse
Management
Along with normal delivery management :
 To assess the effect on the mother and the fetus
 To start a Ringer’s solution drip and to arrange for
blood transfusion, if required
 To exclude rupture of the uterus
 To assess if procedure is to be abandoned and
consider delivery by cesarean section
 Laparotomy should be done in a case with rupture of
uterus.
 To administer parenteral antibiotic
Ventouse delivery

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Ventouse delivery

  • 2. Description  It is an instrumental device designed to assist delivery by creating a vacuum (negative pressure) between itself and the fetal scalp.
  • 3. Definition  Vaccum extraction also known as ventouse, is a method to assist delivery of a baby using a vacuum device. It is a instrumental delivery to assist delivery by creating a vaccum between it and the fetal scalp.
  • 4. Equipment Description  Vacuum extractor is composed of:  A specially designed cup with a diameter of 3,4,5,6 cm or 30,40,50,60 mm.  A rubber tube attaching the cup to a glass bottle with a screw in between to release the negative pressure.  A manometer fitted in the mouth of the glass bottle to declare the negative pressure.  Another rubber tube connecting the bottle to a suction piece which may be manual or electronic creating a negative pressure that should not exceed- 0.8 kg per cm2
  • 5. Part  Suction cup of variable sizes. It is either metallic or soft made of silicone .  Vacuum generator.  Traction tubing.
  • 6. Type  Malmstrom cup A metal cup to its centre attached a metal chain passed through the rubber tube. The other end of the chain is attached to a handle for traction
  • 7.  Bird’s cup The suction rubber tube is attached to the periphery of the cup while the handle of traction is attached by a separate short metal chain to the centre of the cup.
  • 8.  Soft cup It is a bell shaped 6.5 cm diameter soft cup which is made of a firm but supple silastic material.
  • 9.  Kiwi cup It is fexible stem and low profile cup enable placement over the flexion point of the baby’s head no matter the fetal head position.
  • 10. Indications  Maternal indication  Maternal distress: exhaustion after a long, painful labor due to inefficient uterine contraction.  Prolonged second stage of labor.  Maternal medical disorders such as heart diseases, HTN and anemia  Previous cesarean section or genital prolapse repair.  Premature separation of placenta.
  • 11.  Fetal indication  Deep transverse arrest with adequate pelvis.  Delay in descend of the high head in case of the second baby of twins.  Malposition : occipitolateral and occipito posterior.  As an alternative to forceps exept in face presentation and brreech.  Fetal distress
  • 12. Contraindication  Operator inexperience  Inability to assess fetal position  Suspicion of cephalopelvic disproportion  Fetal coagulopathy  Preterm babies due to risk of fetal intraventricular hemorrhage.  Macrosomia >4kg  Soft tissues obstruction in the pelvis  Breach presentation and face presentation
  • 13. Condition to be fulfilled  There should not be any bony resistance below the head  The head of a singleton baby should be engaged  Cervix should be at least 6 cm dilated.
  • 14. Prerequisites  Bladder must be emptied  Cervix fully dilated  No evidence of CPD  Vertex presentation and not above the station of +2  Membrane must be ruptured
  • 15. Technique  Application  Station of the head and its position is assessed  Instrument is checked to be in working condition before application  Selection of cup is important  The cup is introduced after retraction of perineum with two fingers of the other hand  The centre of the cup should be on the flexion point of the head, which is a point located on the sagittal suture, 3cm in front of posterior fontanelle.
  • 16.  Traction at this point results in maximum flexion(flexing median application)
  • 17.  Proper cup placement over flexion point  Exclude maternal soft tissue entrapment by palpation
  • 18.  Vacuum creation by increasing the suction in increments of 0.2 kg/cm2 every 2 mins until 0.8 kg/cm2  A check is made using the fingers round the cup to ensure that no cervical or vaginal tissue is trapped inside the cup .  The pressure is gradually raised at the rate of 0.1kg/cm2 per minute until the effective vacuum of 0.8kg/cm2 is achieved in about 10 minutes time  The scalp is sucked into the cup and an artificial
  • 19.  Instrument handle is grasped, and initiation of traction.  Traction is initiated by using a two-handed technique, i.e the fingers of one hand are placed against the suction cup, while the other hand grasps the handle of the instrument  Traction must be at right angle to the cup  Traction directed initially downward then progressively extended upward as head emerge.  Traction should be synchronous with the uterine
  • 20.  Once head is extracted, vacuum pressure is relieved; cup is removed; vaginal delivery followed.  The total time from the application until delivery should not exceed 20 minutes.  If >20 minutes, the risk of fetal scalp trauma and intracranial damage increases.  Many pulls to achieve progress should not be done .  The operator should be wiling to abandon the procedure if it does not proceed easily or if the cup dislodges >3 times
  • 22. Complications  Fetal complications  Scalp laceration and bruising  Subglial hematoma, Cephalohematoma  Intracranial hemorrhage, intraventricular and cerebral hemorrhages  Retinal and sub-conjunctival hemorrhages  Neonatal jaundice  Clavicular fracture, Shoulder dystocia  Injury to CVI, CVII nerves, Erb palsy  Hypoxia, particularly when extraction has taken a long time and has been difficult  Fetal death
  • 23.  Maternal complications  Soft tissues injuries such as cervical tears, annular detachment of the cervix, vaginal tears, perineal lacerations and tears, extension of episiotomy, vaginal wall and perineal hematomas.  Traumatic postpartum hemorrhages  Infection  Genital prolapse
  • 24. Management Along with normal delivery management :  To assess the effect on the mother and the fetus  To start a Ringer’s solution drip and to arrange for blood transfusion, if required  To exclude rupture of the uterus  To assess if procedure is to be abandoned and consider delivery by cesarean section  Laparotomy should be done in a case with rupture of uterus.  To administer parenteral antibiotic