Managing Complications in Pregnancy and Childbirth: - IAWG

Vacuum extractionP-31FAILURE• Vacuum extraction failed if:- The head does not advance with each pull;- The fetus is undelivered after three pulls with no descent, orafter 30 minutes;- The cup slips off the head twice at the proper direction of pullwith a maximum negative pressure.• Every application should be considered a trial of vacuumextraction. Do not persist if there is no descent with every pull.• If vacuum extraction fails, use vacuum extraction in combinationwith symphysiotomy (see below) or perform caesarean section(page P-43).VACUUM EXTRACTION AND SYMPHYSIOTOMY• Vacuum extraction may be used in combination withsymphysiotomy (page P-53) in the following circumstances:- the head is at least at -2 station or no more than 3/5 palpableabove the symphysis pubis;- caesarean section is not feasible or immediately available;- the provider is experienced and proficient in symphysiotomy;- vacuum extraction alone has failed or is expected to fail;- there is no major degree of disproportion.COMPLICATIONSComplications usually result from not observing the conditions ofapplication or from continuing efforts beyond the time limits statedabove.FETAL COMPLICATIONS• Localized scalp oedema (artificial caput or chignon) under thevacuum cup is harmless and disappears in a few hours.• Cephalohaematoma requires observation and usually will clear in3–4 weeks.