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Intracranial hemorrhage should always be considered in the differential diag- nosis if the baby exhibits abnormal neonatal behavior after difficult vacuum extraction so that early diagnosis may lead promptly to more effective treat- ment.

Dr. Vacca has also published a compre- hensive work concerning use of the vacuum extractor entitled, Handbook of Vacuum Extraction in Obstetric Practice (1992). In the section entitled “Effects of Vacuum Extraction on the Infant,” Dr. Vacca warns:

[D]amage to the falx or tentorium and to their venous sinuses may occur when compression on the head is excessive as may happen when vacuum extraction is attempted in the presence of severe molding.

Vacuum extraction is also correlated with tentorial hemorrhage and mental retardation by the physicians in “Tento- rial Hemorrhage Associated with Vacuum Extraction.” There, the reviewing physi- cians state:

In summary, the use of vacuum extrac- tion may produce ventricle stress on the fetal cranium in the occipitofrontal di- ameter, causing tentorial hemorrhages . . . In two of these patients, the hem- orrhagic complications were associated with diffuse hypoxic-ischemic injury or cerebral infarction.

It has also been noted that:

Tentorial tears have been associated with mechanical injury to the fetal cranium and are thought to be related to the sheering forces on the tentorium result- ing in rupture of the deep venous system or laceration of the inferior sur- face of the cerebellum. Although the pathophysiology is not clearly under- stood, the vacuum extractor may produce stress on the fetal cranium in the occipital frontal diameter, with ten- sion on the tentorium. The tentorium may then rupture, causing intracranial hemorrhage.

In his chapter on cephalopelvic dispro-

portion, in the Manual of Clinical Problems in Obstetrics and Gynecology

Vacuum extraction has also been asso- ciated with the development of dural tears. The application of the vacuum cup to the vertex with longitudinal traction exerts vertical stresses on the tentorium with tearing and hemorrhage similar to that seen with forceps delivery.

While the incidence of intracerebral hemorrhage with vacuum extraction is small, it is increased in situations involv- ing pre-term delivery, and therefore, “. . . pre-term delivery is a relative contraindi- cation for the use of the vacuum extractor.”

(1994), Dr. Sibai states that:

The association of documented CPD with abnormal patterns of progress, in the form of arrest of dilatation or de- scent, is an indication for cesarean birth without any further trial of labor . . . Once CPD is diagnosed, cesarean de- livery is the treatment of choice.

Spring 2006

Trial Reporter


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