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Indications and contraindications for fetal vacuum extraction
Last reviewed: 06.07.2025
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Indications for vacuum extraction of the fetus:
- stable low transverse standing of the sagittal suture;
- incorrect insertion of the head (asynclitism, posterior occipital presentation, etc.);
- lack of progressive advancement of the head along the birth canal, as the most common indication;
- extragenital diseases of pregnant women (cardiovascular diseases, pulmonary diseases) when pressure on the abdominal muscles is unacceptable;
- shortening of the second stage of labor;
- prolonged second stage of labor combined with fetal distress (suffering);
- short second stage of labor;
- fetal distress - in cases where vacuum extraction of the fetus can be performed faster than a cesarean section;
- shortening the second stage of labor as a method of improving the condition of the intrauterine fetus;
- prolapse of umbilical cord loops;
- removal of the head through an incision in the uterus during a cesarean section;
- weakness of labor;
- weakness of labor and risk of fetal asphyxia;
- weakness of labor, endometritis during labor, threat of fetal asphyxia;
- the onset of fetal asphyxia;
- severe forms of late toxicosis - eclampsia, preeclampsia;
- severe psychomotor agitation of the woman in labor during the second stage of labor;
- narrowing of the pelvic outlet;
- premature detachment of the placenta;
- other internal pathology.
Thus, indications for performing vacuum extraction of the fetus are all conditions of the mother and fetus that require faster delivery in the interests of their health and life.
Contraindications to fetal vacuum extraction surgery
A distinction is made between absolute and relative contraindications.
Absolute contraindications:
- discrepancy between the sizes of the pelvis and the fetal head;
- facial presentation;
- breech presentation;
- congenital developmental anomalies;
- stillbirth.
Relative contraindications:
- premature birth - premature baby;
- fetal distress with high acidosis according to acid-base balance data;
- incomplete dilation of the cervical os;
- high standing head;
- after the Zaling test (taking blood from the tissues of the presenting part, in particular, the head of the fetus).
If the indications are taken into account correctly and the technique of the operation is performed accurately, vacuum extraction is not dangerous for the fetus. Conditions for performing the operation:
- objective assessment of the condition of the fetus before surgery;
- precise knowledge of the location of the head in the pelvis;
- use only the large cup of the vacuum extractor;
- sufficient time to create optimal negative pressure (on average from 4 to 6 minutes);
- preventing the cup from being torn off the fetal head.
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