Essentials and tips for ensuring successful vacuum delivery

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Before initating vacuum delivery, there are three things an ob/gyn should focus on:

• Operator experience: Do not attempt if not confident or lacking adequate experience

• Patient selection: Vertex, engaged fetal head, at least ‘0’ station

• Consent: Written consent whenever possible. If oral, discuss potential fetal and maternal risks of the vacuum delivery including but not limited to scalp injuries, cephalohematoma, subgaleal hemorrhage, intracranial hemorrhage and retinal hemorrhage in the fetus and urinary tract as well as anal sphincter injuries and risk of incontinence in the mother

There are two types of vacuum cups:

• Soft bell-shaped cup

• Rigid mushroom cup (also called the M cup)

When applying the vacuum:

• Drain the bladder

• Remember “flexion point” (imaginary point on the sagittal suture which is 2 cm anterior to posterior fontanelle or 3 cm posterior to the anterior fontanelle

• Check for vaginal or cervical tissue

• Apply 450-600 mm Hg pressure

• Synchronize pull with contractions

• Avoid jerking or rocking movements

• Releasing and maintaining pressure between pulls are both acceptable

• No more than 3 pop offs, 3 sets of pulls with no descent, and no more than 30 minutes of total application time

For more information on vacuum delivery: Will vacuum delivery go the way of vaginal breech delivery?