The indications for the use of the SILASTIC®
• The SILASTIC® Obstetrical Vacuum Cup
are made much the same as the forceps operations.
• Appropriate presentation and atti- tude. It may be safer not to use the cup in brow or face presentations.
• No demonstrable clinical cephalopel- vic disproportion.
• Adequate dilatation and effacement of the cervix.
• Ruptured membrane. • Engagement of the head.
Dow specifically states under con- traindications:
Deliveries requiring unusual amounts of traction or rotational forces.
Bulletin 383-289T, March 1989. In March 1989, the SILASTICÆ Ob- stetrical Vacuum Cup Bulletin stated under contraindications:
• Deliveries requiring unusual amounts of traction
• There must be no disproportion be- tween the parturient canal and the presenting fetal part
Obstetrical
Vacuum Cup must never be applied to overcome an absolute mechanical obstacle
The operational guidelines for the use of the MITYVAC©
list as con-
traindications for the use of the vacuum an unengaged presenting part, a breech face/brow presentation or transverse lie, and cephalopelvic disproportion. A state- ment of caution is also provided by the manufacturer as follows:
CAUTION: INCORRECT USE OF THIS DEVICE COULD POSSIBLY CAUSE: PATERNAL SOFT TISSUE INJURIES: VAGI- NAL, CERVICAL, UTERINE, BLADDER AND RECTUM, FETAL BRUISES, CONTUSIONS, LACERATIONS, FRACTURES, INTRACRANIAL HEMOR- RHAGE, CEPHALO- HEMATOMA, SUBDURAL HEMATOMA, SUBGALEAL HEMATOMA, PARENCHYMAL HEMATOMA, AND RETINAL HEMORRHAGE.
Some of the Literature
In Shoulder Dystocia and Birth Injury, Pre- vention and Treatment, James O’Leary, M.D. warns that “both the perturbations of difficult high or mid-forceps delivery or a vacuum extraction of a head wedged within an inadequate tight, bony birth canal, present grave danger of fetal, skull and brain injury. . .” As a general propo- sition, the use of vacuum extractors has been directly linked with cranial trauma, including skull fractures. Trauma, in turn, is a causative agent in cerebral venous thrombosis. Also, by way of example, venous sinus thrombosis has been associ- ated with cranial trauma and instrumental delivery. Moreover, the body of medical litera-
ture contains several studies and articles indicating that vacuum extractors can cause dangerous and life threatening ef- fects as a result of the pressure applied to the area of the venous sinuses. To cite only a few examples, Dr. Aldo Vacca’s pa- per entitled “Birth by Vacuum Extraction: Neonatal Outcome,” indicates that use of vacuum extractors has caused the inci- dence of subgaleal hemorrhage to increase “considerably.” Dr. Vacca writes:
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