Martin L. Gimovsky, MD Program Director, Newark Beth Israel Medical Center, Newark, NJ, and Clinical Professor of Obstetrics, Gynecology and Women’s Health, Mount Sinai School of Medicine, New York, NY Ji-Soo Han, MD Senior Resident in Obstetrics and Gynecology, Newark Beth Israel Medical Center, Newark, NJ
If you are a new physician or lack significant experience with vacuum extraction, ask for input, supervision, and education from more experienced clinicians. Also make it a point to ask about department guidelines and review the credentialing process. Once you become adept at vacuum extraction, mentor more junior colleagues.
Two critical concerns
When contemplating vacuum-assisted delivery, 2 risks are paramount:
failure of the vacuum extractor to achieve delivery
the potential for fetal and maternal injury.
Training must ensure appropriate case selection and technique. Vacuum extraction must be performed with the same precision and care used with forceps. If application of the device is incorrect, or if there is a wrong direction of traction, excessive traction, or traction in the presence of disproportion, the cup will slip or pop off, and vacuum delivery will fail, with the potential for traumatic fetal injury.
All risks must be discussed with the patient to fulfill informed consent, and the risks and benefits of alternative treatments should be part of the discussion. Active participation, in considering how best to approach delivery, is required of all parties concerned.
The vacuum extractor can be a useful adjunct in certain circumstances, and its use has become widespread in American delivery suites. As with the obstetric forceps, which largely antedated its use, the vacuum extractor can lessen the overall risks of childbirth for both mother and infant.
The authors report no financial relationships relevant to this article.
