Gorovitz & Borten, P.C.
Attorneys at Law

550 Cochituate Road, SUite 25
Framingham, Massachusetts
01701
Tel: (781) 890-9095
Vacuum delivery
Vacuum extractors for operative assisted vaginal deliveries require the
application of a soft cup to be applied to the baby's head sufficient to apply
traction to accomplish delivery of the fetal head. Because the vacuum seal is
rarely perfect, periodic application of negative pressure (suction) must be
used. Over the last few decades, the long term safety to the fetus of forceps
operative vaginal deliveries has come into question with the resulting increase
in use of vacuum extractors to accomplish an operative vaginal delivery.
Information supporting a higher incidence of long-term adverse consequences
to the newborn has contributed to the continued controversy whether to
persist in the use of vacuum extractors for operative vaginal deliveries.

At present, vacuum assisted operative vaginal deliveries account for less than
10% of vaginal deliveries. A variety of vacuum instruments have particular
designs for a particular purpose. All vacuum extractors include a rigid or
flexible vacuum cup that applies to the fetal head, a combined vacuum pump
and a handle or chain for traction. Soft vacuum cups have a higher rate of
failure due to the high frequency of spontaneous detachment of the cup from
the fetal head. This may result in the need for multiple applications.

Vacuum extraction deliveries are classified in accordance with the level of
descent of the leading bony point of the fetal head in the mother's pelvis. At
times, vacuum extractors are used to assist during a cesarean section
delivery. Types of vacuum extraction deliveries include:

  • High vacuum operation
  • Mid vacuum operation
  • Low vacuum operation
  • Outlet vacuum operation
  • Vacuum assisted cesarean section

Indications for operative vaginal delivery are similar for vacuum extractors and
forceps. Taking into account that no indication is an absolute indication, they
include:

  • Prolonged second stage without cephalopelvic disproportion
  • Immediate or potential fetal compromise during the second stage of
    labor
  • Interruption of second stage of labor because of acute bleeding,
    cardiac disease, pulmonary disease or maternal exhaustion (see below)

Operative vaginal delivery with vacuum extractor should not be undertaken
without a valid indication. Attempts to shorten labor for maternal and/or
physician's convenience does not support the use of vacuum extractor at any
time. Maternal exhaustion, although a valid indication at times, requires the
medical provider to assess the underlying reason for the maternal exhaustion.
Prolonged labors are quite often an indication of the presence of
cephalopelvic disproportion or fetal malposition. Cephalopelvic disproportion
exists when the the dimensions of the fetal head are larger than the
dimensions of the maternal pelvis. Delivery of such an infant can only be
accomplished at the expense of excessive traction on the fetal head with
consequent injury to the baby. Contraindications to the use of vacuum
extractor include:

  • Inadequate trail of labor
  • Unknown fetal position and station
  • Suspicion of cephalopelvic disproportion
  • Fetal malposition
  • Fetal coagulation disorder
  • Prior failed forceps
  • Inability to achieve proper application
  • Operator's inexperience

Prerequisites for the use of vacuum extractors include:

  • Amniotic membranes must be ruptured
  • Type of pelvis must be known
  • Cervix must be fully dilated
  • Position of the fetal head must be known
  • Fetal head must be engaged in the pelvis
  • No cephalopelvic disproportion is present
  • Adequate anesthesia given
  • Physician must be fully trained in the use of forceps

Operative vaginal delivery increases the risk of neonatal intracranial bleeds
when compared with normal spontaneous vaginal delivery or cesarean
section. Complications associated with vacuum extractor operative vaginal
deliveries can be divided into maternal complications and fetal complications.
Maternal complications with vacuum extractors are fewer and less severe than
with forceps deliveries. Maternal complications include:

  • Lacerations of the vagina
  • Lacerations of the cervix
  • increase in blood loss
  • Hematomas
  • Injury to the urinary bladder
  • Anal sphincter injuries
  • Fecal incontinence

Fetal complications associated with the use of vacuum extractors is low but
can be severe. Subgaleal or subaponeurotic hemorrhage from rupture of the
emissary vein has a mortality rate of 1 in 4 affected infants. Approximately half
of the subgaleal hemorrhages are due to vacuum extractors and the rest are
due to forceps deliveries. fetal complications include:

  • Transient facial bruising or lacerations
  • Cephalohematomas
  • Facial palsy
  • Shoulder dystocia
  • Subgaleal or subaponeurotic hemorrhage
  • Intracranial hemorrhage
  • Tentorial lacerations
  • Cerebral palsy

The combined use of operative vaginal delivery instruments such as forceps
followed by vacuum extractor delivery (or vice-versa) or the multiple attempts
such as more than 3 traction episodes to accomplish delivery are clearly
contraindicated. Regardless of the ultimate success in accomplishing a
vaginal delivery under these circumstances, the risk of neonatal intracranial
hemorrhage is markedly increased.

If your child was delivered by vacuum extraction and is now suffering from a
birth related injury, or you are suffering from a maternal complication,  Dr.
Borten and the Boston area medical malpractice attorneys at Gorovitz &
Borten can help you assert your rights and get the compensation you deserve.

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(when possible), please contact us by phone, fax or e-mail with your question
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