VACUUM EXTRACTION

Oleh: PUTU DION PRATAMA PUJA

17710209
 DESIGN

• Vacuum devices contain a cup, shaft, handle, and vacuum

generator. Vacuum cups may be metal, hard plastic, or soft plastic
and may also different in their shape, size, and reusability.
• Metal cups provide higher success rates but greater rates of scalp
injuries, including cephalohematomas.
• The soft cup is a pliable funnel or bell-shaped dome, whereas
the rigid type has a firm flattened mushroom-shaped cup and
circular ridge around the cup rim, but rigid mushroom cups
generate significantly more traction force
 INSTALATION
• The patient is in a lithotomy position. clean the vulva and
surrounding area,the bladder and rectum must be empty.
• Perform the examination once again at the opening, cervical
and vaginal properties, fetal head and position.
• select the bowl that will be used and sterilize then put it into
the vagina then turn the bowl to the fetus' head
• the location of the bowl must be correct so that the pull is
perpendicular to the bowl
• the duration is not more than 20 minutes or a maximum of 40
minutes
 TECHNIQUE
• An important step in vacuum extraction is
proper cup placement over the flexion point.
This pivot point maximizes traction, minimizes
cup detachment, flexes but averts twisting of
the fetal head, and delivers the smallest head
diameter through the pelvic outlet.
• The flexion point is found along the sagittal
suture, approximately 3 cm in front of the
posterior fontanel and approximately 6 cm
from the anterior fontanel.
• Once suction is created, the instrument handle is grasped, and
traction is initiated. Effort should be intermittent and
coordinated with maternal expulsive efforts
• traction is usually directed initially downward, then
progressively extended upward as the head emerges. Manual
torque to the cup is avoided as it may cause cup displacement
or cephalohematomas
• During pulls, the operator should place the nondominant hand
within the vagina, with the thumb on the extractor cup and one
or more fingers on the fetal scalp
• Once the head is extracted, the vacuum pressure is relieved, the
cup removed, and the usual techniques to complete vaginal
delivery are followed
COMPLICATION
• injury or necrosis on the outer skull of the child in a
bowl placement
• infection if asepsis or antisepsis is not heeded or
less
 Vacuum Mnemonic
A Anaesthesia • Adequate Pain Relief
Assistance • Neonatal Support

B Bladder Bladder Empty

C Cervix Fully Dilated, Membranes Ruptured

D Determine • Position, Station And Pelvic Adequate

• Think Possible Shoulder Dystocia

E Equipment • Inspect Vacuum Cup, Pump, Tubing And Check

Pressure

F Fontanelle • Position The Cup Over The Posterior Fontanelle

• Sweep Finger Around Cup To Clear Maternal Tissue
G Gentle Traction • 100 Mm Hg Initially And Between Contractions
• Pull With Contractions Only
As Contraction Begins:
• Increase Pressure To 600 Mm Hg
• Prompt Mother For Good Expulsive Effort
• Traction In Axis Of Birth Canal
H Halt • No Progress With Three Traction Aided Contractions
• Vacuum Pops-off Three Times
• No Significant Progress After 30 Minutes Of Assisted Vaginal
Delivery
I Incision • Consider Episiotomy If Laceration Imminent

J Jaw • Remove Vacuum When Jaw Is Reachable Or Delivery Assured

 Forcep delivery

• Forceps are a midwifery tool to give birth to a

fetus with a pull on the head, besides that the
device can also be used to rotate the fetal
head
• Forcep is used to help or replace his but
should not be used to force pull out fetus
head if there are obstacles on the birth way
which cannot be overcome by normal his.
Design

• Forceps which is widely used in Indonesia is naegele forceps which

has a curvature of the head, pelvic arches, and a kind of key that
connects two spoons in the right position.
• sometimes kjelland forceps are also used in Indonesia, which does
not have a pelvic arch, with a kind of key that allows forceps to
closed, one spoon shifts in the longitudinal direction against the
other. because it does not have a hip curve this tool is good for
extraction
• Extraction with forceps can be divided into 3 types:
1. High Forceps
if the head of the fetus with the largest size
has not passed the upper pelvis
2. Mid Forceps
if the largest size of the fetal head has passed
the upper pelvis
3. Low Forceps
if the fetal head has reached the bottom of
pelvis
 INDICATION
• Maternal:
heart disease
Eclampsia
Seksio Sesarea at previous delivery
– Foetal:
symptoms of fetal emergency
 CONDITION
• Terms that must be met before doing forceps are:
1. The Cervix Is Fully Open
2. Fetal Head Is Good
3. No Cephalopelvik Disproportion Was Found
4. The Fetal Head Must Be Able To Be Hold By The Forceps
5. Live Fetus
6. Amniotic Membranes Have Ruptured
To determine the complete opening, the examination must be
done carefully and if necessary by inserting 4 fingers into the vagina.
This latest examination also makes it easy to diagnose the position of
the head if there is still doubt in this case. Extracting forceps contains
the danger of cervical injury if the opening is incomplete
 TECHNIQUE

• Before extracting with forceps, first cut or shaved the pubic

hair, and the bladder and rectum are emptied.
• Patient in a lithotomy posisition, disinfection the location
of the external genitalia and the surrounding area, and a
sterile cloth is installed around the surgical area.
• For anesthesia, local anesthesia can be selected or general.
Before being installed, the forceps should be held in a
locked state in front of the vulva according to its position
against the fetal head and pelvic cavity when it is installed
 COMPLICATIONS
• Maternal:
• Injury : Tearing on the uterine cervix
• Bleeding : Injuries can cause bleeding, which
can sometimes a lot and endanger the mother's life.
• Infection : Each vaginal procedure has the risk of
infection, especially if the asepsis and antisepsis are
ignored.
– Foetal
• The most important and most dangerous complication
is fracture skull and bleeding inside the skull