Clinical guidelines. Operative delivery. Vacuum extraction of the fetus. How an emergency vacuum aspiration birth works: types of devices used in obstetrics, consequences for the baby and the course of labor

Extraction of the fetus by the head using a special vacuum apparatus is called vacuum extraction. The operation of vacuum extraction of the fetus is a delivery.

As is known, the most common cause of perinatal morbidity and mortality is fetal oxygen deficiency during childbirth and birth trauma. According to extensive statistics, fetal oxygen starvation and traumatic brain injury account for 50-70% of all deaths in children under one year of age.

The risk of developing a craniocerebral injury during intranatal fetal hypoxia especially increases in cases where obstetric delivery operations are necessary, since there is an overlay of "instrumental" asphyxia on "pre-instrumental" asphyxia.

Vacuum extraction of the fetus is one of the most common delivery operations in Ukraine. The vacuum extractor is used on average 1.3-3.6% in relation to all births in obstetric institutions of the country. However, despite the widespread use of the vacuum extractor in continental Europe and the Scandinavian countries, it should be noted that in most English-speaking countries it remains an unpopular operation. In the United States, there is an extremely reserved attitude towards the operation of vacuum extraction of the fetus compared to obstetrical forceps. This advantage was further strengthened in favor of obstetrical forceps after reports of severe fetal trauma caused by the operation of vacuum fetal extraction appeared in the literature.

American obstetricians rarely use the operation of vacuum extraction of the fetus. This appears to be due to a number of reasons. First, the national preference for obstetrical forceps in the United States depends on the settings that obstetrics is taught. Secondly, some obstetricians, including domestic ones, overestimated the importance of this operation and began to use it according to extended indications, which was not always justified and in some cases led to adverse results, which were revealed in a comprehensive study of newborns and in the analysis of long-term results. Therefore, the positive reviews of many obstetricians who first used this operation were replaced by a more restrained assessment of it and even, to a certain extent, a negative attitude towards it by some specialists due to an increase in the number of children with damage to the central nervous system after surgical delivery by this method.

However, to date there is no single assessment on the application of this operation, the immediate and long-term consequences of the physical and neuropsychic development of a newborn child have not been studied in detail. This is all the more important because in some obstetric situations (if an urgent delivery is necessary, when the moment for a caesarean section is missed or there are contraindications for it, and the head is not available for applying obstetric forceps due to its high location), vacuum extraction of the fetus is the only possible operation for a live birth. Some authors in monographs on craniotomy in modern obstetrics believe that the latter can be considered indicated if there is an immediate threat to the life of the mother in the presence of contraindications to caesarean section or other surgical interventions (imposition of obstetric forceps, classical rotation, etc.).

Therefore, the obstetrician must, in a particular situation, choose the most gentle method of delivery for both the mother and the fetus.

In recent years, for the treatment of intranatal fetal hypoxia, especially in cases of impaired uteroplacental or fetoplacental circulation, when methods of treating fetal hypoxia by influencing the fetus through the mother's body are often ineffective, the method of fetal craniocerebral hypothermia has been successfully used, which makes it possible to directly affect the fetus in order to increase the resistance of the brain to oxygen starvation and prevent the pathological consequences of oxygen deficiency. However, in the available literature there are no works devoted to cranio-cerebral fetal hypothermia in operative obstetrics. For this purpose, the apparatus "Vacuum-hypotherm-extractor" was developed and created, as well as the technique of vacuum-hypotherm-extraction of the fetus. The device allows simultaneously performing cranio-cerebral hypothermia of the fetus and obstetric operations, in particular, vacuum extraction of the fetus.

The use of simultaneous fetal hypothermia during vacuum extraction can reduce the intensity of oxidative and enzymatic processes, slow down the development of acidosis, minimize the so-called “biochemical” injury associated with it, reduce blood flow velocity and volumetric blood flow, improve microcirculation and prevent the development of posthypoxic brain edema. The stay of the fetus under the protection of hypothermia makes it possible to extend the period of time for the production of vacuum extraction of the fetus, to carry out less forced traction compared to conventional vacuum extraction of the fetus. The new surgical technique allows for the most careful delivery, minimizing the possibility of both biochemical and mechanical traumatic brain injury to the fetus. Noting the expediency of using the developed vacuum hypotherm extractor in obstetric practice, Academician M. S. Malinovsky wrote that “simultaneous cranio-cerebral hypothermia is very important to increase the resistance of the brain tissue to oxygen deficiency and prevent injuries during vacuum extraction.”

When determining the place of the operation of vacuum extraction of the fetus in modern obstetrics, the number of pathological conditions in pregnant women and women in labor has not decreased, and the frequency of operative methods of delivery has not decreased. Only the proportion of individual pathological conditions has changed, which to one degree or another can complicate the course of pregnancy and childbirth. In addition, a significant expansion of indications for the use of a vacuum extractor in certain maternity institutions (up to 6-10% in relation to all births) did not reduce perinatal mortality and pathology in them. The possibilities of using a vacuum extractor, which is used in maternity hospitals in Ukraine in 15-35 cases per 1000 births, were soberly assessed.

Vacuum extraction of the fetus does not replace obstetric forceps, it is an independent operation, the use of which has its own indications, conditions and consequences. This operation is theoretically substantiated and, if performed correctly, does not increase the trauma to the fetus in comparison with other delivery operations that remove the fetus through the birth canal. At the same time, it should be noted that at present there is no preferential trend towards the operation of applying forceps in comparison with the operation of vacuum extraction of the fetus.

Indications for vacuum extraction of the fetus

On the part of the mother - complications of pregnancy, childbirth or somatic pathology that require a reduction in the second stage of childbirth:

weakness of labor activity in the second stage of labor;
infectious and septic diseases with a violation of the general condition of a woman, high body temperature.

On the part of the fetus: progressive acute hypoxia (distress) of the fetus in the second stage of labor if it is impossible to perform a caesarean section.

Conditions for performing vacuum extraction of the fetus

Living fruit.
Full opening of the cervix.
Absence of a fetal bladder.
Correspondence between the size of the fetal head and the mother's pelvis.
The fetal head should be located in the cavity of the small pelvis or in the plane of the exit of the small pelvis in the occipital presentation.

To perform the operation of vacuum extraction of the fetus, the active participation of the woman in labor is necessary, since attempts are not turned off during the operation. The presence of diseases in the mother, requiring the exclusion of attempts, is a contraindication to this method of extracting the fetus. The operation is performed under local anesthesia (pudendal anesthesia). If childbirth is carried out under epidural anesthesia, then vacuum extraction is carried out under this type of anesthesia.

Models of vacuum extractors

The vacuum extractor consists of a cup, a flexible hose and a special device that provides a negative pressure under the cup, not exceeding 0.7-0.8 kg/cm2. Vacuum extractor cups can be metal (Matstrom vacuum extractor), more modern models have plastic rigid (polyethylene) or extensible (silicone) disposable cups. In the Maelstrom cup, the tube for creating a vacuum and the chain are in the center. Created modified cups (G.C. Bird): "front" - chain in the center, and the tube to create a vacuum eccentric; "back" - the chain is in the center, and the tube is on the side. These cups are selected depending on the position of the head. Currently, disposable silicone cups are predominantly used.

Fetal vacuum extraction technique

During the operation, the following points are distinguished:

introduction of a vacuum extractor cup;
creating a vacuum using a special device;
traction for the fetal head;
removing the cup.

The insertion of the vacuum extractor cup into the vagina is not difficult. The genital slit is pushed apart with the left hand, and with the right hand, supporting the cup in a vertical-lateral position, it is inserted into the vagina and brought to the head.

The inserted cup "sticks" to the head, after which it should be correctly positioned by moving along the head. The calyx should be located closer to the wire (leading) point on the fetal head, but not on the fontanelles. If the calyx is located 1-2 cm anterior to the small fontanel, during traction the head is bent, which contributes to the fulfillment of the flexion moment of the biomechanism of labor in occipital presentation. If the calyx is attached closer to the large fontanel, the head is extended during traction. Significant displacement of the calyx away from the swept suture during traction contributes to the asynclic insertion of the head.

After placing the cup under it with the help of a special device, negative pressure is created. It should be ensured that soft tissues of the woman's birth canal (cervix, vagina) do not get under the cup.

It is very important to choose the direction of tractions for the successful performance of the operation of vacuum-extraction of the fetus. to ensure the advancement of the head according to the biomechanism of labor, when the wire point of the head moves along the wire axis of the pelvis. Traction should be perpendicular to the plane of the cup. Otherwise, distortion and separation of the calyx from the fetal head are possible.

The direction of traction follows the rules described above for obstetrical forceps. With the position of the head in the plane of entry into the small gas, the traction should be directed downward (with this position of the head, it is more rational to perform a caesarean section); in case of displacement of the head into the cavity of the small pelvis, the direction of traction changes to horizontal (to itself); during the eruption of the head, when the suboccipital fossa approaches the floor of the symphysis, the traction is directed upward. The number of tractions when applying a vacuum extractor should not exceed four.

Vacuum extraction of the fetus is the extraction of the child from the birth canal using a vacuum apparatus. This procedure is used if the second stage of labor is delayed, the child does not move through the birth canal or is under stress.

The vacuum apparatus consists of cups of different diameters and a pump (electric or manual). The first vacuum devices were with metal cups, now they mainly use plastic or silicone, which are less traumatic for the fetus.

The calyx is placed on the fetal head and negative pressure is gradually created in the apparatus, then during the contraction movements are made to help the extraction of the fetus, while the woman in labor is straining.

Anesthesia is usually not used, since the active participation of the mother is necessary, but at the request of the mother, local anesthesia can be performed. Episiotomy (dissection of the perineum) with vacuum extraction is performed infrequently and mainly by primiparas.

Vacuum extraction is used under certain conditions: full opening of the cervix, absence of membranes, correct presentation of the fetus.

A similar vacuum extraction is the procedure for applying obstetric forceps. In principle, these interventions are interchangeable, but the vacuum is used more often, since not all doctors have the skills to use forceps. Cm." " ".

Indications for vacuum extraction of the fetus.

Vacuum fetal extraction is mainly used when it is necessary to urgently remove the baby. There are the following indications for vacuum extraction of the fetus.

Weakness of labor activity.

Fetal hypoxia, if an emergency caesarean section is not possible.

Endometritis in childbirth is an infection of the birth canal, accompanied by fever.

Preeclampsia of moderate and mild degree in the mother.

The presence of an extragenital pathology in the mother (cardiovascular, pulmonary and other diseases), which requires the exclusion or reduction of the period of attempts.

There is a vacuum extraction and contraindications.

Extension insertion of the head - frontal, facial, anterior head presentation. To apply the vacuum, the child must be at the entrance to the small pelvis with the back of the head (occipital presentation).

The discrepancy between the size of the pelvis and the size of the fetal head.

Complications of pregnancy, requiring the complete exclusion of attempts. During vacuum extraction, the woman in labor must push, so when the attempts are completely turned off, forceps are used.

Vacuum fetal extraction: implications for mother and child.

With vacuum extraction of the fetus, less often than with the application of forceps, there are injuries to the mother, but injuries to the child occur more often. The most common consequences of vacuum extraction for the mother are ruptures of the birth canal. Also, the use of vacuum increases the risk of postpartum infectious complications.

The consequences of vacuum extraction of the fetus for a child can be damage to the scalp, difficult birth of the shoulders, hemorrhages in the eyes, hyperbilirubinemia (increased bilirubin or jaundice).

A serious consequence of vacuum extraction is intracranial hemorrhage, but it is extremely rare. A higher likelihood of hemorrhage in premature babies, so they try not to use a vacuum in preterm birth.

After a vacuum, newborns often develop swelling on the head, which disappears within 48 hours and does no harm.

Often there is such an injury as cephalohematoma, in which a subcutaneous cavity filled with blood forms in the damaged area on the head. Small cephalohematomas go away on their own, in some cases medical intervention (puncture) is required.

Most of the damage in the child occurs when the cup of the device repeatedly slips off the fetal head, prolonged attempts to extract or apply excessive force during the procedure.

As for the long-term consequences, such as cerebral palsy, epilepsy, psychomotor retardation, the studies have not proven their connection with instrumental methods of delivery (vacuum, forceps). These diseases are more associated with fetal hypoxia and some pregnancy complications.

In principle, vacuum extraction of the fetus is safe enough for the mother and child, if carried out according to the indications, taking into account all the conditions and observing the execution technique.

If the extraction of the fetus during the birth process occurs with the help of a special obstetric device - a vacuum preparation, then this process is defined in obstetrics as vacuum extraction. Consider the main indications for the use of this delivery procedure.

The need for a vacuum extractor

During labor, every woman in labor has a certain risk of perinatal fetal morbidity and death as a result of acute oxygen deficiency. Lack of oxygen can be observed during the entire process of delivery of a woman.

Unfortunately, the medical statistics are not very encouraging. Approximately 70% of all deaths of children during childbirth and before the onset of their 12 months occur due to traumatic brain injury received during labor and directly during childbirth.

Possible complications of vacuum extraction of the fetus are mechanical damage (ruptures of the vagina), perineum, large and small labia. On the part of the fetus, damage to the soft tissues of the head and profuse hemorrhage are possible.

Today I will tell you about one of the operations that is sometimes performed during delivery. About the vacuum extraction of the fetus. I was very surprised that there is not a single review on Airek about this. Whereas about episiotomy, for example, today there are 52 reviews. Perhaps this indicates the rarity of using this method.

I want to immediately warn you that I have nothing to do with medicine. I am writing from the position of someone who went through this operation and subsequently read a lot about it. So, fellow medical residents of the site, please do not judge strictly.

For moderators: there are also MY photos in the collages!

So, what is vacuum extraction of the fetus:

Vacuum extraction of the fetus is a delivery operation, removing the fetus by the head by creating a negative pressure between the fetal head and the inner surface of the cup of a special apparatus (vacuum extractor).
The vacuum extractor was developed in 1954 by Malmström. The device has a set of cups with a diameter of 5 to 8 cm, each can be connected to a vacuum apparatus equipped with a pressure gauge. Currently, two modifications of the vacuum extractor are used: with a rigid plastic cup and with a softer silicone one.
When applying a vacuum extractor, the participation of the woman in labor is necessary, therefore, when the attempts are completely turned off, only obstetric forceps can be used. For this reason, vacuum extraction of the fetus is a rather rare operation, despite its technical simplicity.

Conditions for the operation:

★ live fetus;
★ full opening of the uterine os;
★ the possibility of active participation of the woman in labor in the process of childbirth;
★ the position of the fetal head in the pelvic cavity;
★ full compliance with the size of the mother's pelvis and the size of the fetal head.

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With theory, like, everything. It's time to tell about yourself.

Vacuum extraction of the fetus is a delivery operation in which the fetus is artificially removed through the natural birth canal using a vacuum extractor.

The first attempts to use the power of vacuum to extract the fetus through the natural birth canal were made in the middle of the last century. The invention of the "aerotractor" by Simpson is dated 1849. The first modern model of a vacuum extractor was designed by the Yugoslav obstetrician Finderle in 1954. However, the design of the Malstrom vacuum extractor, proposed in 1956, was most widely used. In the same year, a model was proposed, invented by domestic obstetricians K. V. Chachava and P. D. Vashakidze.

The principle of operation of the device is to create a negative pressure between the inner surface of the cups and the head of the fetus. The main elements of the apparatus for vacuum extraction are: a sealed buffer container and an associated pressure gauge, manual suction to create negative pressure, a set of applicators (in the Maelstrom model - a set of metal cups from 4 to 7 numbers with a diameter of 15 to 80 mm, in the E.V. Chachava and P.D. Vashakidze - rubber cap). In modern obstetrics, vacuum extraction of the fetus is of extremely limited use due to adverse effects on the fetus. Vacuum extraction is used only in cases where there are no conditions for performing other delivery operations.

Unlike the operation of applying obstetric forceps, vacuum extraction of the fetus requires the active participation of the woman in labor during traction of the fetus by the head, so the list of indications is very limited.

Indications for vacuum extraction of the fetus:

Weakness of labor activity, with ineffective conservative therapy;

Beginning fetal hypoxia.

Contraindications to the operation of vacuum extraction of the fetus:

Diseases that require "turning off" attempts (severe forms of gestosis, decompensated heart defects, high myopia, hypertension), since during the vacuum extraction of the fetus, active laboring activity of the woman in labor is required;

Mismatch between the size of the fetal head and the mother's pelvis;

extensor presentation of the fetal head;

Fetal prematurity (less than 36 weeks).

The last two contraindications are associated with the peculiarity of the physical action of the vacuum extractor, so placing cups on the head of a premature fetus or in the fontanel area is fraught with serious complications.

conditions to perform the operation of vacuum extraction of the fetus consider:

1. Live fruit;

2. Complete opening of the uterine os;

3. Absence of a fetal bladder;

4. Correspondence of the size of the pelvis of the mother and the head of the fetus;

5. The head of the fetus should be in the cavity of the small - pelvis with a large segment at the entrance to the small pelvis;

6. Occipital insertion.

Technique operation of vacuum extraction of the fetus consists of the following points:

1. Introduction of the cup and placing it on the head. The cup of the vacuum extractor can be introduced in two ways: under the control of the hand or under the control of vision (using mirrors). Most often in practice, a cup is introduced under the control of the hand. To do this, under the control of the left hand-guide with the right hand, the cup is inserted into the vagina with the side surface in the direct size of the pelvis. Then it is turned and the working surface is pressed against the head of the fetus, as close as possible to the small fontanel.

2. Create negative pressure. The cup is attached to the device and within 3-4 minutes a negative pressure of up to 0.7-0.8 amt (500 mm Hg) is created.

3. Fetal attraction by the head. Tractions are performed synchronously with attempts in the direction corresponding to the biomechanism of childbirth. In the pauses between attempts, attraction is not produced. It is obligatory to perform trial traction.

4. Removing the cup. When cutting through the vulvar ring of the parietal tubercles, the calyx is removed by violating the seal in the apparatus, after which the head is removed by manual techniques.

Complications. The most common complication is slipping of the calyx from the fetal head, which occurs when there is a leak in the device. Cephalohematomas often occur on the fetal head, cerebral symptoms are observed.

Control questions:

1. The device of obstetrical forceps and models more often used in modern obstetrics.

2. Indications from the part of the woman in labor for the operation of applying obstetric forceps.

3. Indications from the side of the fetus for the operation of applying obstetric forceps.

4. Conditions necessary for the operation of applying obstetric forceps.

5. Methods of anesthesia used in the operation of applying obstetric forceps.

6. The main stages of the operation of applying obstetric forceps.

7. General principles for applying obstetric forceps (three triple rules).

8. Output forceps.

9. Cavity obstetric forceps.

10. Possible complications during the operations of applying obstetric forceps and vacuum extraction of the fetus.