Which statements are true regarding VENTOSE (Vaccum Extractor)
Ans-A i.e. Minor scalp abrasions and subgaleal hematomas in the newborn are more frequent than forceps Conditions to be fulfilledHere is a comparison between Ventouse and ForcepsForcepsVentouseCervix is fully dilated and effacedMembrane must be rupturedThe head must be engagedThere should not be undue obstruction (bony or otherwise at or below the obstruction)Baby should be livingUterus should be preferably contracting and relaxingBladder must be emptiedPresentation and position must be suitable oneVertexAnterior faceAfter coming headThere should not be slightly bony resistance below the headThe head of the baby should be engagedCervix should be at least 6 cm dilatedIndicationForcepsVentouseDelay in the second stage It has the same indications as forceps except thatFetal indicationsMaternal indicationsC/IEspecially used inFetal distress (if vaginal delivery can be performed)Cord prolapseAfter coming head of breechLow birth weightPostmaturityMaternal distressPreeclampsiaPost caesareanHeart diseaseFace presentation or after coming head of breechFetal distress or prematurity1. Deep transverse arrestAdvantagesOf Forceps over VentouseOf Ventouse over Forceps1. In suspected pelvic contraction where moderate traction is required (ventouse will be ineffective)Fetal distressPremature babyAnt. Face presentation or after coming head of breechSimplicity of the instrument, less costly and handyCan be used with advantage in unrotated or malrotated occipito posterior positionCan be applied even through incompletely dilated cervixLess traction force (10 kQ/is needed)Can be used safely even when the head remains highLess injury to motherLess fetal complicationsRequires less technical skillContraindications of Ventouse:Fetal distress - When urgent delivery is needed ventouse takes timeFace presentationPrematurity - chance of scalp avulsion & hemorrhage is moreFetal bleeding disorderComplications of Vacuum extractionScalp lacerationCephalohematomaSubgaleal hemorrhageNeonatal jaundiceRetinal hemorrhageVaginal lacerationFeedback from reader's have shown, there is some confusion about the option 'a' & 'b' to clarify them and further support our answer here are two statements from a reputed book on instrumental deliveries - Dennen' s Forceps' Deliveries 3/e, p 178."Although Malmstrom originally described the application of the Ventouse to a scalp prior to full dilatation of the cervix and at any station of the head, the reported subsequent higher incidence of fetal injury has altered the indicationCurrently, use at high stations and with incomplete cervical dilatation is discouraged""the main disadvantages relate to the fetal effects of the instrument. The artificial caput succedaneum appearance is distasteful, but is only cosmetic and usually disappears in several days. The more severe sequela of scalp trauma including abrasions, laceration or even avulsion of the scalp, may occur. Similarly, ecchymosis, subgaleal hemorrhage cephalhematoma, and retinal hemorrhage have been reported."
Minor scalp abrasions and subgaleal hematomas in new born are more frequent than forceps
Can be applied when the fetal head is above the level of the ischial spine
Maternal trauma is more frequent than forceps
Cannot be used when fetal head is not fully rotated