What are the recommendations for vacuum-assisted vaginal delivery according to the Society of Obstetricians and Gynaecologists of Canada (SOGC) guideline?

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SOGC Guidelines on Vacuum-Assisted Vaginal Delivery

Vacuum extraction is a safe and effective method for assisted vaginal delivery when performed by skilled providers, with proper patient selection and technique.

Indications for Vacuum-Assisted Vaginal Delivery

  • Shortening of the second stage of labor when medically necessary
  • Fetal distress in second stage of labor
  • Maternal exhaustion or inability to push (medical conditions where pushing is contraindicated)
  • Failure to progress in second stage despite adequate contractions

Contraindications

  • Gestational age <34 weeks (due to increased risk of fetal intracranial hemorrhage)
  • Fetal coagulation disorders
  • Fetal demineralization conditions (osteogenesis imperfecta)
  • Previous fetal scalp sampling or application of fetal electrode in current labor
  • Face, brow, or breech presentation
  • Unengaged fetal head
  • Suspected cephalopelvic disproportion

Pre-Procedure Considerations

  • Obtain informed consent explaining risks and benefits
  • Ensure appropriate analgesia/anesthesia (epidural analgesia is recommended) 1
  • Position woman in lateral decubitus position to optimize hemodynamics 1
  • Empty bladder before procedure
  • Perform careful assessment of:
    • Fetal position and station
    • Cervical dilation (must be complete)
    • Adequacy of pelvis

Technique for Vacuum-Assisted Delivery

  1. Cup selection and placement:

    • Soft cups are associated with fewer neonatal scalp injuries but higher detachment rates 2
    • Place cup on the flexion point (3 cm anterior to posterior fontanelle)
    • Ensure no maternal tissue is caught between cup and fetal head

  2. Vacuum application:

    • Create vacuum pressure gradually (increase in increments)
    • Maximum negative pressure should not exceed manufacturer recommendations
    • Traction should be applied perpendicular to cup during contractions
    • Between contractions, maintain vacuum but do not apply traction

  3. Delivery technique:

    • Coordinate traction with maternal pushing efforts and uterine contractions
    • Apply traction in line with the pelvic axis (initially downward, then horizontal, then upward)
    • Support perineum during delivery to reduce risk of tears
    • Consider episiotomy only when clinically indicated (not routine) 3

Safety Parameters

  • Limit procedure to maximum of 3 pulls with proper technique
  • Maximum duration of vacuum application should not exceed 20 minutes
  • Abandon procedure if:
    • No descent with proper traction
    • Cup detaches 3 times
    • No delivery after 3 pulls with proper technique
    • Evidence of fetal scalp trauma

Post-Procedure Care

  • Examine birth canal for lacerations

  • Document procedure details including:

    • Indication for vacuum use
    • Position of fetal head
    • Station before application
    • Number of pulls and pop-offs
    • Duration of procedure
    • Maternal and neonatal outcomes

  • Examine neonate for:

    • Scalp injuries (caput succedaneum, cephalhematoma)
    • Neurological status
    • Need for additional monitoring

Training and Competency

  • Adequate clinical experience and appropriate training are essential for safe performance of vacuum-assisted deliveries 3
  • Hospital credentialing boards should grant privileges only to appropriately trained individuals who demonstrate adequate skills 3
  • Regular skills maintenance and simulation training are recommended

Potential Complications

  • Maternal:

    • Perineal, vaginal, or cervical lacerations
    • Pelvic floor injury
    • Urinary or fecal incontinence

  • Neonatal:

    • Scalp injuries (caput succedaneum, cephalhematoma)
    • Subgaleal hemorrhage (rare but serious)
    • Retinal hemorrhage
    • Jaundice
    • Intracranial hemorrhage (rare)

Benefits of Vacuum-Assisted Delivery

  • Reduces need for cesarean delivery in second stage of labor
  • Shortens second stage of labor
  • May improve maternal and neonatal outcomes when properly indicated
  • Associated with less maternal trauma compared to forceps delivery
  • Can safely reduce the number of second-stage cesarean deliveries with their associated morbidity 4

Vacuum-assisted vaginal delivery remains an important skill for obstetrical care providers. When performed with proper technique and patient selection, it is associated with good outcomes and can help avoid unnecessary cesarean sections.

References

1
Guideline

Labour Management Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

2
Research

Assisted vaginal delivery using the vacuum extractor.

American family physician, 2000

3
Research

Guidelines for operative vaginal birth.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2004

4
Research

Global perspectives on operative vaginal deliveries.

Best practice & research. Clinical obstetrics & gynaecology, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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