Well... O&G posting was pretty fun... Never been this excited to go for night duty before... although the long hours of waiting in the labour room is kinda tiring but when u get to see a delivery u know it's all worth it... Can't wait to go back for hospital posting... community medicine for O&G is BORING!! all u do is just clerk cases and help new mummy with their booking and follow up... If u are lucky u can play with some really cute babies and that's all...
Finally done with my presentation... The topic was quite nice actually... enjoy preparing the slides and reading about it... I don't know... This is my very first time I feel like sharing medicine information on my blog... Will be only focus on the main points and definitely dedicated for those that fall asleep in the class ya!! Please refer to standard textbook for details... (actually nothing much u can find on textbooks too... go read my slides lah!! I send to group email dy~)
Okay let's get it started. (will be in very layman explanation for the non-medical readers)
What's ventouse delivery?
It's a type of assisted instrumental delivery by using a vacuum extractor applied on the baby scalp (head) to pull the baby out from the mother's uterus in order to hasten the second stage of delivery ( a stage in which the baby is being delivered from the mother's womb)...
This is how the machine look like...
Why do we need to use it?
Simple... Just think of any situation that require the shortening of the period of time in second stage of delivery... Let it be prolonged labour ( 2 hours in primigravida - women that's pregnant for the very first time and 3 hours in multigravida - women that's pregnant for twice or more ), maternal condition such as diabetes, hypertension, fetal distress and fetal in occipitoposterior position (for this please remember to use the Bird's modification posterior cup!!)
The flexible silastic cup
Bird's modification posterior cup...
take note that the suction tube is connected to the periphery of the cup...
Is it applicable for all delivery?
Definitely NO! Please remember that it's ONLY for fetus presenting with vertex (baby's head come out first from the mother's womb) and NOT on pre-term babies (those that's less than 34 weeks in gestation)...
How it's done?
The steps are quite simple... Less experience is required compare to forceps delivery...
1. Preparation
Explain to patient the purpose and procedures of the use of vacuum extractor.. please remember that maternal contraction is required for the procedure to be done... ask her to tell you when she begin to contract and when it's end until the next contraction...
Place the mother in lithotomy position and catheterized the bladder (empty the urinary bladder)... Check if the vacuum pump and extractor is working and make sure no leaking in anywhere of the tube because specific pressure is required...
2. Application of vacuum cup
Insert the cup into the vagina and place it as near as possible to the posterior fontanelle over the mid sagittal line with the edge 3cm from the anterior fontanelle... This is to promote flexion of the head and lead the smallest diameter of fetal skull into the maternal passage....
The point where we apply the vacuum cup
3. Creating vacuum
Creating negative pressure by raising the vacuum pressure to 0.2kg/cm²... increase the pressure for 0.2kg/cm² in every minute until the pressure of 0.8kg/cm² is acquired... this is for the chignon formation in the fetal head... (note* this only applied for metal cup... not required in silastic cup due to it's flexibility and ability to grab on the fetal scalp without waiting for the chignon formation) However, the chances for detachment in silastic cup is higher compare to metal cup... BTW... remember to run your finger around the cup to make sure no maternal soft tissues (vagina or cervix) is included in the vacuum cup before applying the pressure...
4. Traction
Apply traction or pull only when the mother contract... Make sure the traction is perpendicular to the fetal head to reduce the chances of cup detachment and also to control the direction of the fetal passage from the mother's womb through the birth canal...
Finally the baby head should be out and the rest of the steps is similar to normal vaginal delivery... detach the cup slowly to prevent any risk of scalp damage... Remember to explain to the concern parents about the chignon at the baby head due to it's disfigurement but it will resolve spontaneously after a day or 2....
Chignon... Don't worry.. It will disappear in at most 2 days..
What's the rule for ventouse delivery?
- The delivery should be completed in not more than 15 minutes.
- The head should descent in each pull.
- The cup should reapplied not more than twice.
- If failure despite good traction, do not try using forceps as well!! prepare the patient for a Caesarean section.
Pros and Cons?
The advantages of ventouse delivery is episiotomy is usually not required and mother still play an active role in the process of delivery... Besides, damage to the fetal head is reduced compare to forceps due to the lower compression force and also reduce the possibility of maternal injury...
Disadvantages... practically nothing much... just remember that ventouse is only applicable for vertex presentation and not for after coming head of breech... maternal effort is required and more expensive compare to forceps...
Well... I guess that's some basic info on ventouse delivery... The video below will actually summarize and u how it's done... enjoy!! *note... not for those weak heart... =)
PS: thanks to Dr Hla Min for sending me the video early midnight... what a dedicated teacher we have!!
