Patient Safety Topics
:
Vacuum-Assisted Vaginal Delivery
Overview

When women in the second stage of labor fail to progress to a spontaneous delivery, vacuum extractors have been used to successfully aid delivery. Like other operative procedures, vacuum-assisted vaginal delivery (VAVD) has known risk factors and complications. To maximize the success of vacuum extraction procedures and to minimize complications, clinicians are well suited to understand both indications and contraindications for this procedure. Performing a thorough preoperative maternal and fetal assessment, technical proficiency with the vacuum device, setting goals, maintaining situational awareness, and concluding the delivery with a targeted postoperative assessment of both the mother and neonate are all important patient safety concepts associated with vacuum-assisted vaginal delivery procedures.

Key Data and Statistics

​Events Reports

Analysis of reports submitted to the Pennsylvania Patient Safety Authority from July 2004 through April 2009 identified 367 reports of problems related to VAVD. Of the 367 reports, 282 (77%) included some form of maternal or neonatal injury. Sixty-four of the reports (17%) documented maternal injury, including third- and fourth-degree perineal tears, cervical lacerations, vaginal sulcus tears, hematomas, anal sphincter tears, and postpartum hemorrhage. Two hundred twenty-one reports (60%) documented neonatal injury, including scalp lacerations, cephalhematomas, epidural, subdural and subgaleal hematomas (SGHs), fractures, and respiratory distress. Fifty-one reports (14%) were serious injuries, including four neonatal deaths (1%) (see Table). One root-cause analysis was reported, and the reported root cause was “communication among staff members.” The top three most frequently cited contributing factors in the Authority reports were “procedures not followed,” “communication problems between providers,” and “issues related to proficiency.”

Table. Maternal and Neonatal Serious Injuries by Type ​ ​ ​
Type and Number of Maternal Injury Type and Number of Neonatal Injury
Perineal or cervical tears or lacerations resulting in hemorrhage and blood transfusion8Fractured clavicle or humerus11
Fourth-degree perineal tears requiring operative repair4Respiratory distress9 (2 deaths)
Miscellaneous lacerations requiring operative repair3Cephal, subdural, or subgaleal
hematoma or skull fracture
8 (1 death)
Vaginal sulcus tears requiring operative repair2Miscellaneous injuries6 (1 death)

 

Technical Expertise

Because a number of fetal injuries associated with vacuum extraction are related to misplacement of the cup, the material of the cup may be less important than correct placement. Because a number of fetal injuries associated with vacuum extraction are related to misplacement of the cup, the material of the cup may be less important than correct placement. When the fetus is in the occipital posterior (OP) or occipital transverse (OT) position, or when there is a significant amount of asynclitism, then the rigid OP cup may be suitable, as these are the only type of cups that can be maneuvered easily to the flexion point (see Figure).

Figure. Flexion Point

Excerpted from: Preventing maternal and neonatal harm during vacuum-assisted vaginal delivery. Pa Patient Saf Advis 2009 Dec 16. http://patientsafety.pa.gov/ADVISORIES/Pages/2009sup1_07.aspx.

Educational Tools

Perinatal Bundle—Vacuum Bundle
Using this retrospective chart review tool may help determine if a bundle of interventions for vacuum delivery is consistently implemented and documented.

Vacuum Extraction—Don't Get Sucked In!

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