Vacuum extraction (VE), also known as ventouse, is a method to assist delivery of a baby using a

vacuum A vacuum (: vacuums or vacua) is space devoid of matter. The word is derived from the Latin adjective (neuter ) meaning "vacant" or "void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressur ...

device. It is used in the second stage of

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

if it has not progressed adequately. It may be an alternative to a

forceps delivery Obstetrical forceps are a medical instrument used in childbirth. Their use can serve as an alternative to the ventouse (vacuum extraction) method. Medical uses Forceps births, like all assisted births, should be undertaken only to help p ...

and

caesarean section Caesarean section, also known as C-section, cesarean, or caesarean delivery, is the Surgery, surgical procedure by which one or more babies are Childbirth, delivered through an incision in the mother's abdomen. It is often performed because va ...

. It cannot be used when the baby is in the

breech position Breech may refer to: * Breech (firearms), the opening at the rear of a gun barrel where the cartridge is inserted in a breech-loading weapon * breech, the lower part of a pulley block * breech, the penetration of a boiler where exhaust gases leave ...

or for

premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...

s. The use of VE is generally safe, but it can occasionally have negative effects on either the mother or the child. The term ''ventouse'' comes from the French word for "suction cup".

Medical uses

There are several indications to use a vacuum extraction to aid delivery: * Maternal exhaustion * Prolonged second stage of labor * Foetal distress in the second stage of labor, generally indicated by changes in the foetal heart-rate (usually measured on a CTG) * Maternal illness where prolonged "bearing down" or pushing efforts would be risky (e.g. cardiac conditions, blood pressure, aneurysm, glaucoma). If these conditions are known about before the birth, or are severe, then an elective

may be performed.

Technique

The woman is placed in the lithotomy position and assists throughout the process by pushing. A

suction cup A suction cup, also known as a sucker, is a device or object that uses the negative Pressure#Fluid pressure, fluid pressure of air or water to adhere to Porosity, nonporous surfaces, creating a Vacuum, partial vacuum. Suction cups occur in nat ...

is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the flexion point, about 3 cm anterior from the occipital (posterior)

fontanelle A fontanelle (or fontanel) (colloquially, soft spot) is an anatomical feature of the infant human skull comprising soft membranous gaps ( sutures) between the cranial bones that make up the calvaria of a fetus or an infant. Fontanelles allow ...

, is critical to the success of a vacuum extraction. Ventouse devices have handles to allow for traction. When the baby's head is delivered, the device is detached, allowing the birthing attendant and the mother to complete the delivery of the baby. For proper use of the ventouse, the maternal

cervix The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...

has to be fully dilated, the head engaged in the birth canal, and the head position known. Preferably the operator of the vacuum extractor needs to be experienced in order to safely perform the procedure. The baby should not be

preterm Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...

, previously exposed to scalp sampling or failed

. If the ventouse attempt fails, it may be necessary to deliver the infant by forceps or

History

In 1849 the

Edinburgh Edinburgh is the capital city of Scotland and one of its 32 Council areas of Scotland, council areas. The city is located in southeast Scotland and is bounded to the north by the Firth of Forth and to the south by the Pentland Hills. Edinburgh ...

professor of obstetrics James Young Simpson, subsequently known for pioneering the use of

chloroform Chloroform, or trichloromethane (often abbreviated as TCM), is an organochloride with the formula and a common solvent. It is a volatile, colorless, sweet-smelling, dense liquid produced on a large scale as a precursor to refrigerants and po ...

in childbirth, designed the Air Tractor which consisted of a metal syringe attached to a soft rubber cup. This was the earliest known vacuum extractor to assist childbirth but it did not become popular. Swedish professor Tage Malmstrom developed the ventouse, or Malmstrom extractor in the 1950s. Originally made with a metal cap, new materials such as plastics and siliconised rubber have improved the design so that it is now used more than forceps. Vacuum delivery as a percentage of vaginal births vary depending on location. In the USA they comprise about 10% to 15% of vaginal births while in Italy 4.8% of vaginal births were delivered via vacuum in 2013.

Comparisons to other forms of assisted delivery

Positive aspects

* An

episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing ...

may not be required. * The mother still takes an active role in the birth. * No special

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

is required. * There is less potential for maternal trauma compared to forceps and caesarean section.

Negative aspects

* The baby will be left with a temporary lump on its head, known as a chignon. * There is a possibility of

cephalohematoma A cephalohematoma (American English), also spelled cephalohaematoma (British English), is a hemorrhage of blood between the skull and the periosteum at any age, including a newborn baby secondary to rupture of blood vessels crossing the periosteu ...

formation, or

subgaleal hemorrhage Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis (dense fibrous tissue surrounding the skull). Symptoms The diagnosis is generally clinical ...

which can be life-threatening. * There is a higher risk of failure to deliver the baby than with forceps, and an increased likelihood of perineal trauma.

References

{{Authority control Childbirth Medical equipment Obstetrical procedures