Vacuum Extraction (Ventouse)

Ventouse extraction is the traction of fetal head by a created negative pressure through a cup
applied to the head on presence of maternal effort. Ventouse is an instrumental device designed
to assist delivery by creating a vacuum between it and the fetal head.
The vacuum extractor introduce by Malinstrom in 1954. Vacuum extractor is composed of a
specially designed cup with a diameter of 3,4,5 or 6 cm. A rubber tube attatching the cup to a
glass bottle with a screw in between to release the negative pressure. A manometer fitted in the
mouth of the glass bottle to declare the negative pressure. Another rubber tube connecting the
bottle to a suction piece which may be manual or elcetronic creating a negative pressure that
should not exceed -0.8 kg per cm2.
Types
The main difference between vaccum extractors lies in the cup.
a. Malinstrom cup
b. Birds cup
c. Soft cup
a. Malinstrom cup
A metal cup to its centre attached a metal chain passed through the rubber tube. The other end of
the chain is attached to a handle for traction.
b. Birds cup
The suction rubber tube is attached to the periphery of the cup while the handle of traction is
attached by a separate short metal chain to the centre of the cup.
c. Soft cup
It is a bell-shaped 6.5 cm diameter soft cup which is made of a firm but supple silastic material.
Parts of Malinstrom instruments
1.
2.
3.
4.

The metal cup available in 3 sizes of 40mm, 50mm and 60mm

Hallow tubing
Glass trap bottle with manometer
Chain attached to the cup which passes through taping and attaches to a cross bar handle
used for traction
5. Suction tube.
Indication
Maternal
1. Maternal distress in 2nd stage of labour
2. Prolonged 2nd stage of labour

3. Maternal medical disorders like heart disease, hpertension, diabetes mellitus, severe
anaemia
4. Elderly primigravidae
5. PIH, Eclampsia
Fetal
1.
2.
3.
4.

Fetal distress in 2nd stage of labour

Cord prolapse in 2nd stage of labour
Non rotated head, occipito posterior position
Relatively higher station, + 2 or just above.

Contraindication
1. Malpresentation
2. Premature fetus (<34 wop)
3. Major degree of CPD
4. Suspected fetal macrosomia
5. High station of the head (above Zero station)
6. IUFD
7. Congenital anomalies of fetus such as anencephaly
8. Tranverse lie
9. Lack of expertise in the procedure
10. Incomplete dilation of cervix
Advantages
1. Easy to application
2. Safety for mother and fetus
3. Less trauma to the fetus and mother
Disadvantage
It slips more than the metal cup but with less scalp injuries.
Requirements or criteria for vacuum extraction
1.
2.
3.
4.
5.
6.
7.
8.

Cervix should be fully dilated

Bladder should be empty
No evidence of CPD
Vertex presentation
Head must be up to +2 station
There is indication to hasten delivery
Full term fetus
The obstetrician is well trained in the use of instrument.

Procedure
1. Prepare all the necessary equipment.

2.
3.
4.
5.
6.
7.
8.

Informed and written consent about indication, give mother choices.

Provide emotional support and reassurance as feasible.
Placed the patient in lithotomy position.
Put on personal protective barriers.
Clean the vulval parts with antiseptic solution and draped with sterile sheets.
Ensure that the bladder is empty if not catheterization should be done.
Vaginal examination should be done to check pelvic capacity, cervical dilatation,
presentation, position, station, sagital suture line and degree of flexion of the head and the
membranes are ruptured.
9. Check all connection on the vacuum extractor and test the vacuum on golved hand.
10. Choose the largest cup that can apply it over the fetal scalp with the centre of the cup
over the flexion point 1 cm posterior to the posterior fontanelle.
11. Assess the position of fetal head by feeling the sagittal suture line and fontanelle.
12. Perform the episiotomy as required.
13. Apply the cup and make sure no maternal tissue within the rim of cup.
14. Create a vacuum 0.2kg/cm2 gradually innegative pressure gradually increased by
0.2kg/cm2 every 1 minute until 0.8kg/cm2 (550 600mmHg) is attained. This creates
artificial caput within the cup.Check application of cup.
15. After maximum negative pressure, start traction in the line of the pelvic axis and
perpendicular to the cup. If the fetal head is tilted to one or not flexed well, traction
should be directed in a line that will try to correct the tilt or deflexion of the head.
16. Traction should be done with each contraction. Place a finger on the scalp next to the cup
during traction to assess potential slippage and descent of the verrtex.
17. Once the head is down on the perineum, apply traction in the horizental then upward
direction.
18. Encourage the woman to bear down as normal during the contraction.
19. Check FHS and application of the cup between contraction but no traction is applied.
20. The delivery is usually completed within 3-5 pulls over a period of 15 minutes.
21. When the head has been delivered, release the pressure from the vacuum extractor
slowly, remove the cup and complete delivery as usual.
22. The total time from application of cup until delivery should not exceed 20 minutes as the
risk of fetal scalp trauma and intracranial damage.
23. Give injection oxytocin 10 units IM for active management of third stage of labour.
24. Check the birth canal for tear after delivery and repair episiotomy.
25. If vacuum fails delivery by Caesarean section.

Vacuum Failure:
a. Head does not advance with each pulls.
b. Fetus is undelivered after 3 pulls or after 30 minutes.
c. Cup slip off the head twice at proper direction of pull with a maximum negative pressure.