This page contains a Flash digital edition of a book.
Relative contraindications for vacuum extraction include prematurity, suspected macrosomia, suspected fetal coagulation defect, fetal scalp blood sampling, and a non-vertex presentation.

Noting that at the time literature for the safety of the soft cup vacuum was sparse, the following criteria were suggested:

Descent of the fetal head must occur with each push-pull effort and delivery should be completed or almost com- pleted in three pulls. The fetal head should be completely delivered within fifteen minutes after the cup is first ap- plied.

The Bulletin ends with the statement that:

As with forceps procedures, there must be a willingness to abandon attempts at vacuum extraction if progress does not proceed easily.

This Technical Bulletin was superseded by another one issued in August 1994, which reaffirmed that:

. . . indications, preparation of the pa- tient, definitions, and pre-requisites for vacuum extraction are essentially the same as for forceps delivery.

They noted that one exception was that the vacuum extractor can often be used with less anesthesia than would be re- quired for forceps delivery. One significant change in the Techni- cal Bulletin appears on page four:

There is a lack of consensus regarding the number of pulls required to effect delivery, the maximum number of cup detachments that can be tolerated, and the total duration of the procedure. These issues have not been subjected to rigorous scientific study and should be based on the judgment of the op- erator or supervisor and clinical circumstances. As a general guideline, progress in descent should accompany each traction attempt.

Of significant importance is the final statement that:

As with forceps procedures, there should be a willingness to abandon at- tempts at vacuum extraction if satisfactory progress is not made.

Since the indications for vacuum extrac- Spring 2006

St. Paul & Biddle Medical Associates/ Pacific Rehab

Toll Free: 888-522-8822 410-685-7790

* Orthopedics * Neurology

* Physical Therapy * Radiology

* EMG Nerve Conduction Studies “No fee for court testimony”

Quality Healthcare providers specializing in the treatment of patients injured in automobile accidents and on the job since the 1980’s.

Main office – Downtown Baltimore

Northwest/Patterson Ave Northeast/Sinclair Lane

( At the corner of St. Paul & Biddle Streets) Bel Air

West Baltimore/Garwyn South Baltimore/Cherry Hill Highlandtown

Loch Raven/Northern Pkwy St. Agnes/Wilkens Ave

Towson/Lutherville Rosedale/Golden Ring/Essex

Parkville/Carney/White Marsh Catonsville

Randallstown Dundalk

Owings Mills/Reisterstown Glen Burnie

Annapolis Trial Reporter 33

Edgewood Columbia


Westminster Frederick

Hagerstown Cumberland

Waldorf/Southern Maryland Temple Hills/Washington Silver Spring/Wheaton

Salisbury Cambridge

tion are essentially the same as for forceps delivery, the cervix should be completely dilated, the membranes should be rup- tured, and the fetal head should be engaged. With regard to the determina- tion of station, significant caput formation can lead an obstetrician to misjudge where the bony part of the head actually is lo- cated. The contraindications, therefore, include: •CPD • Face or brow presentation • Breech presentation • Unengaged fetal head • Premature infant • Incompletely dilated cervix

Dr. Robert H. Hayashi, in his chapter on ventouse delivery, notes that:

Caution should be used if a vacuum ex- tractor is used on a fetus who has had fetal scalp blood samplings performed earlier in labor, since there has been one report of an exsanguination of an in- fant when ventouse delivery followed fetal blood sampling.

The Manufacturers

Dow Corning, in its literature dealing with the SILASTIC®

Obstetrical Vacuum Cup, under general indications, states:

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52