VACUUM ASSISTED VAGINAL

DELIVERY (VENTOUSE)
 VENTOUSE is an
instrumental device designed to
assist delivery by creating a
vacuum between it and the fetal
scalp.
 It is traction of the fetal head by
a created
 negative pressure through a cup
applied to the head.
Instruments:
 MALSTORM DEVICE (1956) was popularized in its use,
but now there are various modifications available.
Cups:
 METAL CUPS.
 SOFT CUPS.
 SILIC CUPS (Silicon rubber or disposable plastic cups
have better adherence to the fetal scalp.
 These cups could be folded and introduced into the
vagina without much discomfort.
 Silastic cups causes less scalp trauma and there is a
chignon formation.
 Rigid plastic cup ( Kiwi, omnicup) is safe, effective
and is useful for rotational delivery.
Metal cup:
Soft cups:
Silic cups:
Cup sizes:
 A suction cup with 4 sizes (30mm, 40mm 50mm &
60mm).
Indications for operative vaginal
delivery

Maternal Fetal Others

Indications:
MATERNAL FETAL
 Inadequate expulsive  Fetal distress ( LBW
efforts. baby, Postmaturity).
 Maternal exhaustion.  After coming head of
 Expulsive efforts to be breech.
avoided. ( Cardiac  Suspicion of fetal
disease, hypertensive compromise.
crisis, cerebrovascular
diseases)
Cont.,.,
 OTHERS:
 Prolonged 2nd stage o labor (Nullipara: > 2hrs &
Multipara: > 1hr).
 To cut short the 2nd stage of labor as in (Severe
preeclampsia, cardiac disease & post cesarean pregnancy).
Contra Indications of ventouse:
 Any presentation other than vertex ( Face, brow, breech).
 Preterm fetus.
 Chance of scalp avulsion or subaponeurotic hemorrhage.
 Suspected fetal coagulation disorder.
 Unengaged fetal head.
 Obvious CPD.
 Fetus having unacute bleeding diathesis (Hemophilia).
Prerequisites for operative vaginal
delivery
FETAL & MATERNAL CRITERIA:
 Fetal head engaged ( Head is < 1/5 palpable per abdomen).
 The cervix must be fully dilated.
 The membranes must be ruptured.
 Fetal head position is exactly known.
 Pelvis deemly adequate.
 Bladder must be emptied.
 Adequate maternal analgesia ( Regional block for midcavity or
pudental block).
 Informed consent (verbal or written) with prior clear
explanation.
Cont.,.,.
OTHERS:
 Experienced operator.
 Aseptic techniques.
 Back up plan in case of failure.
 Willingness to abandon the procedure when difficulties
faced.
Procedure:
PRELIMINARIES
 The procedure to be followed before the operative or
manipulative obstetrics.
1. Anesthesia: Either general or local is used. (In some
cases, IV diazepam sedation is used).
2. Position: LITHOTOMY position is used.
3. Full surgical asepsis is to be taken:
Surgeon has to wear sterile mask,
gown & gloves.
Cont.,.,
 Vulva & vagina are to be swabbed with antiseptic
solution.
 Cervix is cleaned with povidone iodine solution.
 The perineum is to be draped by sterile towel and the legs
with leggings.
4. Empty the bladder:
If the patient is ambulant, she is asked to empty
the bladder before she is placed on the table, otherwise
CATHETARIZATION is to be done.
Cont.,.,
5. Vaginal Examination:
Vaginal examination must be done.
Pudental block or perineal infiltration with
1% lignocaine is sufficient.
It may be applied even without anesthesia
specially in parous women.
The instrument should be assembled and the
vacuum is tested prior to its application.
Step 1:
 Application of cup:
 The largest possible cup according to the dilatation of
cervix is to be selected.
 The cup is introduced after retraction of the perineum
with 2 fingers of the hand.
 The cup is placed against the fetal head nearer to the
occiput (Flexion point) with the knob of the cup pointing
towards the occiput.
 This will facilitate flexion of the head and the knob
indicates the degree of rotation.
Cont.,.,
 Betadine (antiseptic) solution is applied to the rim of the
malstorm metal cup.
 A vacuum of 0.2 kg/cm2 is induced by the pump slowly,
taking at least 2 minutes.
 A check is made using the fingers round to cup to ensure
that no cervical or vaginal tissue is trapped inside the cup.
 The pressure is gradually raised at the rate of 0.12kg/cm2
per minute until the effective vacuum of 0.8 kg/cm2 is
achieved in about 10 minutes time.
Cont.,.,
 The scalp is sucked into the cup and an artificial caput
succedaneum (CHIGNON) is produced. The chignon
usually disappears within few hours.
Step 2:
Cont.,.,.
Cont.,.,
Vacuum delivery
Advantages of vacuum over forceps
 Anesthesia is not required so it is preferred in cardiac and
pulmonary patient.
 The ventouse is not occupying a space beside the head as
forceps.
 Less compression force (0.77 kg/cm2) compared kg/cm2)
so injuries to the head is less common.
 Less genital tract lacerations.
 Can be applied before full cervical dilatation.
 It can be applied on non-engaged head.
Disadvantages of vacuum over
forceps
 Require maternal effort
 Equipment more complex and may fail.
 Takes time may leads to fetal distress.
 Cannot be used in preterm.
 More cephalo hematoma.
Complications of ventouse:
NEONATE MATERNAL
 Superficial scalp  Uncommon injuries.
abrasion.  May be due to inclusion
 Cephalohematoma. of the soft tissues such as
 Subaponeurotic cervix or vaginal wall
(Subgaleal hemorrhage). inside the cup.
 Intracranial hemorrhage
(Rare).
 Retinal hemorrhage.
 Jaundice.