Vacuum Extractor Patel

8/8/2019 Vacuum Extractor Patel

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The Vacuum

Extractor

(The Ventouse)


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By

Dr.Narayan M.PatelM.D.,D.G.O. FICS

Mahalaxmi Institute of medical

teaching,3, Shantiniketan park, Naranpura,

Nr.Sardar Patel Colony,

AHMEDABAD- 380 014 (Gujarat) INDIAT.N.(079) 27682572, Mobile 98252 95530E mail:- [email protected]


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Historical aspect

1705:- James young ,first usedtraction instrument to assist delivery

by using a cupping-glass fixed to

the scalp with a air pump.After 144 years in1849:-- Simpson (Edinburgh) first

described and used first suctiontractor made from couscous and

shaped like cup.


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Historical aspect

In 1953:--

Malstrome of Gotherburg

(Sweden) first presented hisfirst model V/E-53 and

called Ventouse or Vacuumextractor.


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Historical aspect (cont)1963:- Chalmeru (U.K.) wrote

classical monogram on ventouse

1969:-- Bird modified Malstromsoriginal cup

1973:- Paul developed novel

plastic instrument.


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Historical aspect (cont)

1981;-ONeil -most recenttraction chain linked to a

ring on the cup

1984:- Kobayashi

introduced silasticvacuum extractor.


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Parts of Ventouse(1)Stainless steel cups in 4 sizes,

30, 40, 50, 60 mm in diameter

Silastic cups are lighter.(2)The depth of cup is 20 mm.

The greatest diameter of cup is

8 mm below the point ofapplication.


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Parts of Ventouse .

3)The metal plate

4) The traction handle

5) Suction bottle

6) Vacuum release valve


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B

irds modification of Ventouse(1)The suction nozzle is

located excetrically nearthe

rim of the cup, so thatsuction and traction can both

be applied with a better

effect.


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Requirements to be fulfilled beforeapplication of vacuum extractor:--

(1)Cervix should be fully dilated.

(2)Bladder should be empty.(3)Head, well engaged in presence

of good uterine contractions.

(4)No evidence of cephalo pelvicdisproportion.


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The advantages of Vacuumextractor are:--

(1)Ease of application

(2)Encouragement of

autorotation

(3)safety for both mother andfoetus.


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The pressure is slowlyraised 0.1 kg/cm/min.

until it reaches0.8 kg/cm. The Total

time taken should beabout 8 minutes.


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Artificial caput

called asCHIGNON by

Rosa in 1955


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Chignon is a

oedematous artificial

caput,formed beneath

the vacuum cup.


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Largerthe cup,The greaterthe adhesion

AndMore the force you canapply .


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Indication of vaccum application:-

(1)Fetal indications:- Fetal distress in second stage of labor

Prolapsed cord or fetal distress after 7cm.of cervical dilatation

(2)Maternal Indications:- Maternal physical distress Pt.. With cardiac disease/ hypertension


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Indication of vacuum application(cont.)

(3)Obstetric indications:- Delay second stage of labor Prolonged labor

Mal rotation of fetal head

Delivery of second child in twins.


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Prolonged second stage

or poor maternal effort

was the indication forvacuum extractor delivery

in 52.8% of patients.


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When the least modest

traction is expected,

than lithotomy position

is a favored position.


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Ventouse exert 4 types of

forces on the fetal scalp.:1)Negative suction from the

vacuum it self.

2)Downward traction from pulling.

3)Circular force, if rotation occurs.

4)Shearing force if the directionof traction is not perpendicular

to the scalp surface.


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Simpson claimed thatvacuum enable the

obstetrician to add a fewpounds to every pain and

by this,make completion of

delivery safer and faster.


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Oblique pull is more

likely to dislodge thecup than a

perpendicular pull.


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The hissing noise

suggest a leak.It is a warning hiss.


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The ventouse allowsthe head to come

the way it wants to,even some times

face to pubis


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Delivery of the head atcesarean section with the

ventouse, is sometimes

advocated.

In some countries ventuose

is used by paramedicalpersonnel's also.


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Delivery of second twinwith head not engaged,

is the only permissibleindication to use

vacuum, when the headis above the brim.


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Complications of Vacuum delivery:--

Maternal complications :-

Vaginal lacerations &hemorrhage.

Annular detachment of cx.

V.V.F. is also reported.


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Complications of Vacuumdelivery

Fetal complictions (cont):-

5)Jaundice due to absorptionof pigments.

5) Intracranial damage6)Baldness over scalp.


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Complications of Vacuumdelivery:--

Fetal complictions :-

1)Scalp aberation2)Scalp ecchymoses.

3)Cephal hematoma.4)Subgallal hematoma


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Symphysiotomy +Ventouse sequence

is quite a popular

method of delivery inAfrican countries.


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One of the major

advantage of the vacuum

extractor is that whentraction is too great ,the

cup dislodges.


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We do not talk about bruteforce in obstetrics, but still

practice brute forceps.

Ventouse is simply a form

of skin traction as

employed in orthopedicsurgery.


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Prejudiced arguments

are often base oninexperience

Bryan Hibbard


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The most violent criticism ofthe ventouse nearly always

comes from those people who

have the least experience in

using it, commonly none at

all. Ian Doland


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Vacuum Extractor Patel

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