Assisted delivery of high floating fetal head: a comparison of vacuum-assisted delivery with manual extraction

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Background: It is a well-established obstetric practice to use a vacuum device to assist in delivery of the fetal head at cesarean delivery. As a vacuum sauce, the hospital piped-vacuum supply is often used. However, no study has compared the safety and efficacy of vacuum-assisted delivery with the traditional manual extraction.

Objective: Compare the safety and efficacy of delivery of the high floating fetal head using a soft cup vacuum extractor with the traditional manual extraction.

Methods: This randomized study included 90 cases of caesarean sections with vacuum-assisted delivery using the soft cup vacuum extractor (V group) and 90 cases of caesarean sections with manual extraction of the head (M group). The hospital piped-vacuum supply was used to develop the required vacuum. Operative and postoperative maternal and neonatal data of importance were analyzed using Student t-test for continuous variables and Chi Square test for categorical variables.

Results: The U-D interval (the time of entry into the uterus until the full delivery of the fetal head) was significantly prolonged (p <0.001) in M group (86.3±53.9 and 65.3±31.2 seconds, respectively). Mean blood loss in the V group was higher (576.7±182.9 mL and 504.4±204.9 mL, respectively). However, this difference was not statistically significant (p=0.306). There was no difference in the Apgar scores and resuscitation in the newborns of the two groups. Infants did not show evidence of any scalp remarks.

Conclusion: The extraction of the fetal head at caesarean section with vacuum extractor was a non-traumatic and rapid method that did not need the prolonged fundal compression and thus avoid unwanted consequences.

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  • 1. Hankins GDV Clark SL Cunningham FG Gilstrap LC.

  • Operative obstetrics Norwalk:Appleton & Lange;

  • 1995. p. 318.

  • 2. Pelosi MA Apuzzio J. Use of the soft silastic obstetric vacuum cup for delivery of the fetal head at cesarean section. J Reprod Med. 1984; 29:289-92.

  • 3. Arad I Linder N Bercovici B. Vacuum extraction at cesarean section-neonatal outcomes. J Perinatal Med. 1986; 14:137-40.

  • 4. Simonson C Barlow P Dehennin N Sphel M Toppet V Murillo D Rosenberg S. Neonatal complications of vacuum- assisted delivery. Obstet Gynecol. 2007; 109: 626-33.

  • 5. Clark SL Vines VL Belfort MA. Fetal injury associated with routine vacuum use during cesarean delivery. Am J Obstet Gynecol. 2008; e4.

  • 6. Miksovsky PWatson WJ. Obstetricvacuum extraction: state of the art in the new millennium. Obstet Gynecol Survey. 2001; 56:736-51.

  • 7. Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953; 32: 260-7.

  • 8. Kim TY Ryu DH. The effect of fundal pressure at Caesarean section on maternal haemodynamics.

  • Anaesthesia. 2006; 61:434-8.

  • 9. Wylie B. Traction in forceps deliveries. Am J Obstet Gynecol. 1935; 29:425-33.

  • 10. Vacca A. Handbook of Vacuum Delivery in Obstetric Practice.Brisbane Australia:Vacca Research 2003.

  • 11. Boehm FH. Vacuum extraction during cesarean section.

  • South Med J. 1985; 78:1502.

  • 12. Nakano R. Use of the vacuum extractor for delivery of the fetal head at cesarean section. Am J Obstet Gynecol. 1981; 141:475-6.

  • 13. Lim FT Holm JP Schuitemaker NW Jansen FH Hermans J. Stepwise compared with rapid application of vacuum in ventouse extraction procedures. Br J Obstet Gynaecol. 1997; 104:33-6.

  • 14. Svenningsen L. Birth progression and traction forces developed under vacuum extraction after slow or rapid application of suction. Eur J Obstet Gynecol Reprod Biol. 1987; 26:105-12.

  • 15. Solomons E. Delivery of the head with the Malmstrom vacuum extractor during cesarean section. Obstet Gynecol. 1962; 19:201-3.

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