From the Guidelines
Vacuum-assisted delivery is indicated when there is a need to expedite vaginal delivery during the second stage of labor, particularly in cases of prolonged second stage of labor, maternal exhaustion, or certain fetal conditions, as supported by the most recent evidence 1. The primary indications for vacuum-assisted delivery include:
- Prolonged second stage of labor (typically >2 hours in nulliparous women with epidural anesthesia, >1 hour without epidural, or >1 hour in multiparous women with epidural, >30 minutes without epidural)
- Maternal exhaustion
- Certain fetal conditions such as non-reassuring fetal heart rate patterns requiring prompt delivery
- Medical conditions that limit a mother's ability to push effectively, such as cardiac disease, pulmonary conditions, or neurological disorders For vacuum-assisted delivery to be performed safely, several prerequisites must be met:
- The cervix must be fully dilated
- The fetal head must be engaged (station +2 or lower)
- The exact position of the fetal head must be known
- Membranes must be ruptured
- The maternal pelvis must be deemed adequate The procedure should only be performed by trained practitioners who can recognize contraindications such as fetal coagulation disorders, prior fetal scalp sampling, prematurity (<34 weeks), or suspected macrosomia, as highlighted in recent studies 1. It is essential to note that vacuum-assisted delivery should be avoided in cases where the fetus is suspected to have a bleeding phenotype, such as afibrinogenemia or severe hypofibrinogenemia, due to the risk of significant fetal injury 1. In general, the management of impacted fetal head at cesarean delivery is complex and requires careful consideration of various techniques, including reverse breech extraction, as discussed in recent literature 1. However, the primary focus should always be on minimizing the risk of fetal injury and ensuring the best possible outcomes for both the mother and the baby.
From the Research
Indications for Vacuum Assisted Delivery
- Prolonged second stage of labor 2, 3, 4
- Non-reassuring fetal heart rate or fetal distress 5, 3
- Dystocia 2
Maternal and Neonatal Complications
- Vacuum assisted delivery is associated with higher rates of maternal morbidity and mortality compared to Caesarean delivery among women with dystocia 2
- Vacuum delivery is associated with lower rates of maternal morbidity and mortality compared to Caesarean delivery in cases of fetal distress 2
- Neonatal complications such as cephalohematoma, low 5-min Apgar-score, and asphyxia are more common in the non-reassuring fetal heart rate group 3
- Neonatal sepsis is more common in cases of prolonged second stage of labor 3
- Post-partum hemorrhage, cephalohematoma, and caput succedaneum are significantly higher among vacuum deliveries 4