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.”
Type and Number of Maternal Injury||||
Type and Number of Neonatal Injury|||
|Perineal or cervical tears or lacerations resulting in hemorrhage and blood transfusion||8||Fractured clavicle or humerus||11|
|Fourth-degree perineal tears requiring operative repair||4||Respiratory distress||9 (2 deaths)|
|Miscellaneous lacerations requiring operative repair||3||Cephal, subdural, or subgaleal
hematoma or skull fracture
|8 (1 death)|
|Vaginal sulcus tears requiring operative repair||2||Miscellaneous injuries||6 (1 death)|
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).
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.