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

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.