Vacuum extraction (VE), also known as ventouse, is a method to assist delivery of a baby using a

vacuum A vacuum is a space devoid of matter. The word is derived from the Latin adjective ''vacuus'' for "vacant" or " void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressure. Physicists often ...

device. It is used in the second stage of

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the la ...

if it has not progressed adequately. It may be an alternative to a

forceps delivery Obstetrical forceps are a medical instrument used in childbirth. Their use can serve as an alternative to the ventouse (vacuum extraction) method. Medical uses Forceps births, like all assisted births, should only be undertaken to help prom ...

and

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or m ...

. It cannot be used when the baby is in the

breech position A breech birth is when a baby is born bottom first instead of head first, as is normal. Around 3–5% of pregnant women at term (37–40 weeks pregnant) have a breech baby. Due to their higher than average rate of possible complications for the ...

or for

premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between ...

s. The use of VE is generally safe, but it can occasionally have negative effects on either the mother or the child. The term comes from the French word for "suction cup".

Medical uses

There are several indications to use a vacuum extraction to aid delivery: * Maternal exhaustion * Prolonged second stage of labor * Foetal distress in the second stage of labor, generally indicated by changes in the foetal heart-rate (usually measured on a CTG) * Maternal illness where prolonged "bearing down" or pushing efforts would be risky (e.g. cardiac conditions, blood pressure, aneurysm, glaucoma). If these conditions are known about before the birth, or are severe, then an elective

may be performed.

Technique

The woman is placed in the

lithotomy position The lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of ...

and assists throughout the process by pushing. A

suction cup A suction cup, also known as a sucker, is a device or object that uses the negative Pressure#Fluid pressure, fluid pressure of air or water to adhere to Porosity, nonporous surfaces, creating a Vacuum, partial vacuum. Suction cups are peripher ...

is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the

flexion point In obstetrics, the term flexion point refers to a spot on the fetal head on which the cup of a ventouse should to be placed for extraction of the child to be most effective. When the cup of the ventouse is applied on the flexion point, the fetal he ...

, about 3 cm anterior from the occipital (posterior)

fontanelle A fontanelle (or fontanel) (colloquially, soft spot) is an anatomical feature of the infant human skull comprising soft membranous gaps ( sutures) between the cranial bones that make up the calvaria of a fetus or an infant. Fontanelles allow ...

, is critical to the success of a vacuum extraction. Ventouse devices have handles to allow for traction. When the baby's head is delivered, the device is detached, allowing the birthing attendant and the mother to complete the delivery of the baby. For proper use of the ventouse, the maternal

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

has to be fully dilated, the head engaged in the birth canal, and the head position known. Preferably the operator of the vacuum extractor needs to be experienced in order to safely perform the procedure. The baby should not be preterm, previously exposed to scalp sampling or failed

. If the ventouse attempt fails, it may be necessary to deliver the infant by forceps or

History

In 1849 the

Edinburgh Edinburgh ( ; gd, Dùn Èideann ) is the capital city of Scotland and one of its 32 Council areas of Scotland, council areas. Historically part of the county of Midlothian (interchangeably Edinburghshire before 1921), it is located in Lothian ...

professor of obstetrics

James Young Simpson Sir James Young Simpson, 1st Baronet, (7 June 1811 – 6 May 1870) was a Scottish obstetrician and a significant figure in the history of medicine. He was the first physician to demonstrate the anaesthetic properties of chloroform on humans a ...

, subsequently known for pioneering the use of

chloroform Chloroform, or trichloromethane, is an organic compound with chemical formula, formula Carbon, CHydrogen, HChlorine, Cl3 and a common organic solvent. It is a colorless, strong-smelling, dense liquid produced on a large scale as a precursor to ...

in childbirth, designed the Air Tractor which consisted of a metal syringe attached to a soft rubber cup. This was the earliest known vacuum extractor to assist childbirth but it did not become popular. Swedish professor Tage Malmstrom developed the ventouse, or Malmstrom extractor in the 1950s. Originally made with a metal cap, new materials such as plastics and siliconised rubber have improved the design so that it is now used more than forceps.

Comparisons to other forms of assisted delivery

Positive aspects

* An

episiotomy Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening ...

may not be required. * The mother still takes an active role in the birth. * No special

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

is required. * There is less potential for maternal trauma compared to forceps and caesarean section.

Negative aspects

* The baby will be left with a temporary lump on its head, known as a chignon. * There is a possibility of

cephalohematoma A cephalohaematoma is a hemorrhage of blood between the skull and the periosteum of any age human, including a newborn baby secondary to rupture of blood vessels crossing the periosteum. Because the swelling is subperiosteal, its boundaries are ...

formation, or

subgaleal hemorrhage Subgaleal hemorrhage, also known as subgaleal hematoma, is bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis. Symptoms The diagnosis is generally clinical, with a fluctuant boggy mass developing over the ...

which can be life-threatening. * There is a higher risk of failure to deliver the baby than with forceps, and an increased likelihood of perineal trauma.

References

{{Authority control Childbirth Medical equipment Obstetrical procedures