Ventouse

Ventouse
Intervention
A baby's scalp showing the effects of a vacuum extraction (chignon). The effects were gone a week later.
ICD-9-CM	72.7

Ventouse is a vacuum device used to assist the delivery of a baby when the second stage of labour has not progressed adequately. It is an alternative to a forceps delivery and caesarean section. It cannot be used when the baby is in the breech position or for premature births. This technique is also called vacuum-assisted vaginal delivery or vacuum extraction (VE). The use of VE is generally very safe, but it can occasionally have negative effects on either the mother and the child.^[1]

Contents 1 Technique 1.1 Indications for use of vacuum 2 Comparisons to other forms of assisted delivery 2.1 Positive aspects 2.2 Negative aspects 3 External links 4 References

Technique

The woman is placed in the lithotomy position and assists throughout the process by pushing. A suction cup is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the flexion point, about 3 cm anterior from the occipital (posterior) fontanelle, is critical to the success of a VE.^[2] Ventouse devices have handles to allow for traction. When the baby's head is delivered, the device is detached, allowing the accoucheur and the mother to complete the delivery of the baby.

For proper use of the ventouse, the maternal cervix has to be fully dilated, the head engaged in the birth canal, and the head position known. If the ventouse attempt fails, it may be necessary to deliver the infant by forceps or caesarean section.

Indications for use of vacuum

There are several indications to use a ventouse to aid delivery:

• Maternal exhaustion
• Prolonged second stage of labor
• Foetal distress in the second stage of labor, generally indicated by changes in the foetal heart-rate (usually measured on a CTG)
• Maternal illness where prolonged "bearing down" or pushing efforts would be risky (e.g. cardiac conditions, blood pressure, aneurysm, glaucoma). If these conditions are known about before the birth, or are severe, then an elective caesarean section may be performed.

Comparisons to other forms of assisted delivery

Positive aspects

• An episiotomy may not be required.
• The mother still takes an active role in the birth.
• No special anesthesia is required.
• The force applied to the baby can be less than that of a forceps delivery, and leaves no marks on the face.
• There is less potential for maternal trauma compared to forceps and caesarean section.

Negative aspects

• The baby will be left with a temporary lump on its head, known as a chignon.
• There is a possibility of cephalohematoma formation, or subgaleal hemorrhage.

External links

• Ventouse Delivery Video from the American Medical Videos Journal

References

Obstetrical surgery and other procedures (ICD-9-CM V3 72-75, ICD-10-PCS 1) Diagnostic Pregnancy test sampling: fetal tissue (Chorionic villus sampling · Amniocentesis) · blood (Triple test · Percutaneous umbilical cord blood sampling · Apt test · Kleihauer-Betke test) · Lecithin-sphingomyelin ratio · Fetal fibronectin test obstetric ultrasonography: Nuchal scan · Biophysical profile (Amniotic fluid index) other medical imaging: Fetoscopy Cardiotocography · (Nonstress test) · Vibroacoustic stimulation challenge: Contraction stress test Leopold's maneuvers Intervention Fetal surgery · Fetendo · Podalic version (External cephalic version) · Amnioinfusion Delivery Vaginal delivery Induction (Artificial rupture of membranes/Amniotomy) · Episiotomy · Symphysiotomy · Forceps in childbirth · Ventouse in childbirth shoulder dystocia (McRoberts maneuver, Woods' screw maneuver, Zavanelli maneuver) · Manual placenta removal Caesarean section Elective · On maternal request · EXIT procedure Postpartum hemorrhage Hysterectomy · B-Lynch suture · Sengstaken-Blakemore tube M: OBS phys/devp/memb mthr/fetu/infc, epon proc, drug(2A/G2C)