Advantages of vacuum extraction of the fetus

Over the years, there has been controversy about the benefits of the operation of applying obstetrical forceps or vacuum extraction of the fetus. Plauche concluded that with the technically correct and shown in each case application of a vacuum extractor, it is effective and less traumatic than other delivery methods. When analyzing the current data on the operation of superimposing forceps and vacuum extraction, it can be said that vacuum extraction is less traumatic and is especially necessary when the inner turn of the head is not completed, and the sagittal is in the transverse dimension of the pelvis. Moreover, when comparing the effect of vacuum extraction and caesarean section, some authors conclude that vacuum extraction is a less traumatic operation for both the mother and the fetus. It should be noted that at the same time a number of authors carry out perfection of both the apparatus and the operation of vacuum extraction of the fetus.

At present, a large number of studies devoted to the operation of vacuum extraction of the fetus have been published. At the same time, in the opinion of the majority of domestic and foreign clinicians, the latter is most preferable with persistent weakness of labor, prolonged II period of labor, endometritis. It should be noted that often in these situations there is intrauterine fetal asphyxia. Thus, according to research, in 55% of cases, the main causes that cause obstetricians to perform vacuum extraction of the fetus with full and incomplete opening of the cervix were a violation of the state of the intrauterine fetus against the background of persistent weakness of labor activity that can not be medicated.

It is important to note here that for the successful carrying out of vacuum extraction of the fetus, it is necessary to perform the exact operation with the knowledge of the biomechanism of the birth. Appropriate preparation of the device is necessary with a check of its tightness, preparation of the parturient for the operation as in other delivery operations through natural birth canals, adequate anesthesia taking into account the condition of the mother and the fetus. Extremely important selection of the vacuum extractor cup. It is recommended to use the largest size of the vacuum extractor cup (No. 6 or No. 7), of course, if the degree of opening of the uterine throat allows.

In this case, most obstetrician doctors do not resort to vacuum extraction of the fetus until the uterine throat is fully opened. However, there are reports of the use of vacuum extraction of the fetus with incomplete opening of the uterine throat. In the domestic literature, the use of a vacuum extractor for delivery with incomplete cervical dilatation is known as vacuum stimulation of labor, with full vacuum extraction of the fetus. As is known, with forceps, the traction depends on the strength of the operator. Mathematical calculations showed that during the operation of imposing obstetric forceps, the force is 20 times greater than with vacuum extraction of the fetus. Moreover, it is shown that vacuum extraction requires only less than 40% of the thrust force applied when applying obstetric forceps. It has also been shown that vacuum extraction is safer compared to the operation of applying obstetrical forceps, especially the weekend ones. However, when time is needed for the rotation of the head or during the process of lowering the high-head, the total compression and the levels of traction are equal to or even higher than when applying obstetric forceps. It is especially important to conduct attracting tractions in synchronism with a fight or an attempt, they must stop simultaneously with the fight. Tractions must necessarily be perpenidicular plane of the calyx, since so-called "oblique" tractions lead to a redistribution of the pressure forces at different poles of the cup and it will press inside the cutaneous surface of the fetal head. In this case, if there is no progress in advancing the presenting part, it is necessary to choose another method of delivery after 3 or 4 tracts, for if the vacuum cup breaks, the fruit can get injured. When abrasions or lesions of the fetal head skin are detected, reapplying the vacuum extractor cup is dangerous. If there is no damage, the vacuum extractor can be reapplied. Thus, the general rule is as follows: if the cup is separated from the fetal head 3 times or more, or the total duration of the vacuum extraction exceeds 30 minutes, the vacuum extraction operation must be stopped.

A significant advantage of vacuum extraction is the lack of the need for additional increase in the volume of the presenting part, as is observed in the operation of applying obstetrical forceps. When fetal asphyxia, vacuum extraction is used in 2.5-44.5% of observations. In this case, it is believed that when the cervix is fully opened and the head located in the pelvic cavity or pelvic floor, the acute asphyxia of the intrauterine fetus is an indication for the imposition of obstetric forceps. However, according to the authors' data, vacuum extraction was performed in 24.4% only in connection with the onset of fetal asphyxia: in the initial stages of asphyxia, high position of the head, or, conversely, when the head is incised, and insufficiently active tensions, anatomically narrowed pelvis, etc. , that when fetal asphyxia is recommended to use an output vacuum extractor. For this, doctors are asked to use a large cup (60 mm in diameter) with an instant increase in the vacuum to 0.8 kg / cm ². This is sufficient for the immediate extraction of the fetus without forming the inside of the cup at the expense of the fetal head tissue of the so-called "artificial generic tumor." Complications from the mother and fetus, as a rule, are minimal. The use of a modified vacuum extractor cup and electric pumps to create a vacuum dramatically changed the technical problems, thereby greatly improving the immediate and long-term results of this operation.

One of the most extensive studies is a study by modern authors Vacca et al, in which a comparison of obstetric forceps and vacuum extraction of a fetus is carried out under identical conditions. It is shown that the trauma in the mother, blood loss in childbirth, the use of analgesics were significantly lower in the group with the use of a vacuum extractor. However, according to the authors, the latter may predispose to an increase in the amount of mild jaundice in newborns. At the same time, vacuum extraction reduced the injury to the mother 2 times from 25% to 12.5%. In children born with obstetric forceps, the condition was more severe than with vacuum extraction of the fetus. It is important to note that the average time between the imposition of a vacuum cup or forceps and subsequent delivery was the same for both groups - 26 min, with an average duration of period II - 92 min. In children, subcutaneous hematomas were more frequent in the operation of superimposing obstetric forceps, but in most cases they were small - less than 2.5 cm in diameter. At the same time, the cephalohematoma was more frequent in the vacuum extraction of the fetus, but the difference was large only at presence of small cephaloids with a diameter of less than 2.5 cm. Extensive cephalohematomas were one in two groups. These data show that after an unsuccessful application of obstetric forceps, they usually go on to abdominal delivery. At the same time, after the vacuum extraction operation of the fetus, which ended unsuccessfully, usually try (sometimes unsuccessfully) to impose obstetrical forceps before resorting to cesarean section. Differences in professional skills lead to the tendency of the vacuum extractor to be imposed by most young obstetricians, as indicated by a number of authors. Most operators who have experience in applying obstetric forceps use them, so they are more often imposed by obstetricians with more experience.

Thus, vacuum extraction of the fetus extends the possibilities of operative delivery through the natural birth canal. At the same time, a number of modern obstetricians believe that obstetric forceps and vacuum extraction of the fetus can be used for the same indications. Other authors believe that vacuum extraction of the fetus is indicated mainly in conditions where extraction of the fetus with obstetric forceps is impossible. Modern methods of operative delivery through the natural birth canal, in spite of the great achievements in practical obstetrics, are still sufficiently imperfect. Their use should be carried out according to strict indications and high-qualified doctors, however, an attempt to replace them with the caesarean section in the interests of the fetus can not be accepted by domestic midwives.

[1], [2], [3], [4], [5]