Ventouse Delivery
INTRODUCTION:
- Ventouse is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
- The pulling force is dragging the cranium while in forceps, the pulling force is directly transmitted to the base of the skull
INSTRUMENTS:
Components:
- Soft cups, silc cup
- The cup is connected to a pump through a thick-walled rubber tube by which air is evacuated.
- Vacuum is created by a hand pump or by electric pump.
- The parts of the device are:
- Suction cups with four sizes (30 mm, 40 mm, 50 mm and 60 mm)
- Vacuum generator
- Traction tubings
INDICATIONS:
- Inadequate expulsive efforts
- Maternal exhaustion (distress)
- Where expulsive efforts (Valsalva) are to be avoided (e.g. cardiac disease, hypertensive crises, cerebrovascular diseases, spinal cord injury)
- Nonreassuring fetal heart rate— fetal distress (e.g. low-birth-weight baby, postmaturity)
- After-coming head of breech
- Suspicion of fetal compromise
- Prolonged second stage of labor (nullipara >2 hour; multipara >1 hour)
- To cut short the second stage of labor as in severe preeclampsia, cardiac disease, postcesarean pregnancy
- Prerequisites for Operative Vaginal Delivery (Forceps or Vacuum Application)
CONTRAINDICATIONS:
- Face, brow, breech presentation
- Preterm fetus (< 34 weeks).
- Chance of scalp avulsion or subaponeurotic hemorrhage
- Suspected fetal coagulation disorder
- Suspected fetal macrosomia (>=4 kg)
- Unengaged fetal head
- Obvious CPD
- Patient’s refusal
- Hemophilic patient
PREREQUISITES:
- Fetal head engaged
- The cervix must be fully dilated
- The membranes must be ruptured
- Fetal head position is exactly known
- Pelvis deemed adequate
- Bladder must be emptied
- Adequate maternal analgesia
- Informed consent
- Experienced operator
- Aseptic techniques
- Back up plan and facilities in case of failure
- Presence of a neonatologist
- Willingness to abandon the procedure when dffculties faced
PROCEDURE:
Application of the cup:
- Perineum retraction with 2 fingers
- Cup placed against fetal head at flexion point with the “knob” of the cup pointing towards the occiput.
- Vacuum of 0.2 kg/cm2 is induced taking at least 2 minutes
- Check to ensure that no cervical or vaginal tissue is trapped inside the cup
- Pressure raised with rate of 0.1 kg/cm2 per minute till 0.8 kg/cm2 achieved in 10 min
- Artificial caput succedaneum (chignon) is produced that disappears in few minutes.
Traction:
- Right angle to the cup
- Synchronous with the uterine contractions
- Made using one hand along the axis of the birth canal
- Fingers of the other hand are placed against the cup to note the correct angle of traction, rotation and advancement of the head
- On head delivery vacuum is reduced by opening the screw-release valve and the cup is detached.
- Delay in first stage due to uterine inertia & descent of high head in case of second baby of twins
COMPLICATIONS:
Neonate:
- Superficial scalp abrasion
- Sloughing of the scalp
- Cephalhematoma
- subaponeurotic (subgaleal) hemorrhage
- Intracranial hemorrhage (rare)
- Retinal hemorrhage (no long-term effect)
- Jaundice
Maternal:
- Injury due to inclusion of the soft tissues
ADVANTAGE OVER FORCEP DELIVERY:
- Can Be used in unrotated or malrotated head
- Not a space-occupying device
- Traction force is less (10 kg) compared to forceps
- Comfortable and has lower rates of maternal trauma and genital tract lacerations
- Analgesia need is less
- Reduced maternal pelvic floor injuries
- Perineal injury (3rd and 4th degree tears) are less
- Postpartum maternal discomfort (pain) are less
- Easier to learn comparing to forceps
- Convenient
Exam Question
- There is Less maternal trauma by vacuum as compared with forceps
- Cephalohematoma is more common with vacuum extraction
- Retinal hemorrhage, intracranial hemorrhage and subgaleal hemorrhage are more common in ventouse delivery than forceps
- Foetal macrosomia, Face presentation & Transverse lie are contraindications of ventouse extraction
- Ventouse can be used to treat deep transverse arrest
- In deep transverse arrest with adequate pelvis, best mode of delivery will be Ventouse
- Ventouse extraction is done in Delay in first stage due to uterine inertia
- Ventouse extraction is done in Delay in descent of high head in case of second baby of twins
- Ventouse application, the prerequisite is Head engaged
- During application of the cup in Ventouse, ‘knob’ of the cup points towards Occiput
- Pressure in ventouse assisted delivery is 0.8 kg/sq.cm
Don’t Forget to Solve all the previous Year Question asked on Ventouse Delivery
