From the Guidelines
Vacuum-assisted delivery (Ventouse) is contraindicated in several clinical scenarios, including suspected fetal coagulopathy or active bleeding disorders, as stated in the most recent study 1, and when the fetus is suspected to have afibrinogenemia or severe or moderate hypofibrinogenemia, as suggested by 1. The procedure should not be performed when the fetal head is unengaged or when the position of the fetal head is unknown or unstable. Some key contraindications to vacuum delivery include:
- Gestational age less than 34 weeks due to increased risk of fetal intracranial hemorrhage in premature infants whose skulls are not fully developed
- Suspected fetal coagulopathy or active bleeding disorders, such as afibrinogenemia or hypofibrinogenemia, as they increase the risk of cephalohematoma and intracranial bleeding 1
- Previous fetal scalp sampling or application of a fetal scalp electrode at the proposed vacuum site due to increased risk of scalp injury
- Relative contraindications include suspected macrosomia, previous failed forceps attempt, and certain fetal malpositions such as face or brow presentations
- Maternal factors that may contraindicate vacuum delivery include HIV infection with high viral load due to increased risk of vertical transmission, and certain maternal pelvic abnormalities The use of a vacuum at cesarean delivery has the potential to cause significant fetal injury, such as intracranial and subgaleal hemorrhage, as noted in 1 and 1. Therefore, the use of vacuum-assisted delivery should be avoided in these scenarios to prevent trauma to the fetal scalp, reduce the risk of intracranial hemorrhage, and avoid situations where vacuum delivery is likely to fail, potentially leading to more serious complications.
From the Research
Contraindications to Vacuum Delivery
The following are contraindications to vacuum delivery:
- Previous cranial injury or hemorrhage in the fetus 2
- Fetal coagulopathy or thrombocytopenia 3
- Fetal bone demineralization disorders (e.g. osteogenesis imperfecta) 3
- Presence of fetal scalp electrodes or other instruments that may interfere with vacuum extraction 4
- Face or brow presentation of the fetus, as vacuum extraction is associated with increased risk of facial trauma in these cases 5
- Breech presentation, as vacuum extraction is not recommended for breech deliveries due to increased risk of complications 6
- Placenta previa or other conditions that may increase the risk of maternal bleeding or other complications 4
- Previous uterine surgery, such as cesarean section or myomectomy, which may increase the risk of uterine rupture during vacuum extraction 3
Relative Contraindications
Relative contraindications to vacuum delivery include:
- Prolonged second stage of labor, as prolonged attempts at vacuum delivery may increase the risk of neonatal morbidity and maternal trauma 2
- Fetal distress or other signs of fetal compromise, as vacuum extraction may exacerbate these conditions 4
- Maternal medical conditions, such as hypertension or heart disease, which may increase the risk of complications during vacuum extraction 3
- Operator inexperience or lack of training in vacuum extraction techniques, as this may increase the risk of complications 5, 4