Managing Complications in Pregnancy and Childbirth: - IAWG

P-28 Vacuum extractionFIGURE P-7Landmarks of the fetal skull• Apply the largest cup that will fit, with the center of the cup overthe flexion point, 1 cm anterior to the posterior fontanelle. Thisplacement will promote flexion, descent and autorotation withtraction (Fig P-8).FIGURE P-8Applying the Malmstrom cup• An episiotomy may be needed for proper placement at this time(page P-71). If an episiotomy is not necessary for placement, delaythe episiotomy until the head stretches the perineum or theperineum interferes with the axis of traction. This will avoidunnecessary blood loss.• Check the application. Ensure there is no maternal soft tissue(cervix or vagina) within the rim.