From the Guidelines
Forceps are preferred over vacuum extractors in clinical scenarios requiring more control and rotational force, such as non-reassuring fetal heart rate patterns, persistent occiput posterior or transverse positions, after-coming head of a breech presentation, or delivery of the head during cesarean section, as evidenced by recent studies 1.
Indications for Forceps
- Non-reassuring fetal heart rate patterns requiring immediate delivery
- Persistent occiput posterior or transverse positions requiring rotation
- After-coming head of a breech presentation
- Delivery of the head during cesarean section
- Preterm deliveries (less than 34 weeks) due to the risk of cephalohematoma and intracranial hemorrhage with vacuum use in premature infants
Indications for Vacuum Extractor
- Prolonged second stage of labor with maternal exhaustion
- Need for expedited delivery with minimal maternal pushing efforts
- When minimal assistance is needed to complete delivery However, vacuum extraction is contraindicated in pregnancies less than 34 weeks, face presentations, or suspected fetal bleeding disorders, as highlighted in a recent study 1.
Operator Experience and Training
The choice between forceps and vacuum should consider operator experience, as proper training is essential for safe application of either instrument, with high-fidelity simulation and implementation of standardized care pathways likely to represent the safest and most effective form of training 1.
Risks and Complications
Both methods carry risks including maternal perineal trauma and neonatal injuries, though the specific complications differ between the two approaches, with vacuum extractors potentially causing significant fetal injury, such as intracranial and subgaleal hemorrhage, as noted in a recent study 1.
From the Research
Indications for Forceps and Vacuum Delivery
The decision to use forceps or vacuum delivery in obstetrics depends on various factors, including the stage of labor, fetal position, and maternal and fetal well-being.
- Forceps delivery is often used when the fetal head is low in the birth canal and the mother is unable to push the baby out on her own 2, 3.
- Vacuum delivery, on the other hand, is commonly used when the fetal head is at a higher station in the birth canal and the mother needs assistance with delivery 3, 4.
- Both forceps and vacuum delivery can be used to expedite delivery in cases of maternal exhaustion or fetal distress 5, 6.
Comparison of Forceps and Vacuum Delivery
Studies have compared the outcomes of forceps and vacuum delivery, including maternal and neonatal morbidity and mortality.
- Forceps delivery has been associated with a higher risk of maternal trauma, including third- and fourth-degree perineal tears, and neonatal complications, such as cephalohematoma 2, 4.
- Vacuum delivery, on the other hand, has been associated with a lower risk of maternal trauma and neonatal complications, but a higher risk of failed delivery and subsequent cesarean section 3, 6.
- The choice between forceps and vacuum delivery ultimately depends on the individual circumstances of each patient and the judgment of the attending obstetrician 2, 3.
Pelvic Floor Damage
Operative vaginal delivery, including forceps and vacuum delivery, can cause damage to the pelvic floor and perineal structures.