Editing Vacuum extraction

{{Short description|Method to assist the delivery of a baby}}
{{redirect|Ventouse|the commune in France|Ventouse, Charente}}
{{About|a medical procedure|the skin suction pseudoscience|Cupping therapy}}
{{More medical citations needed|date=February 2022}}
{{Infobox interventions
|  Name        = Vacuum extraction
| synonyms     = Ventouse, vacuum-assisted vaginal delivery
|  Image       = Vacuum Extraction bruised scalp.JPG
|  Caption     = A baby's scalp showing the effects of a vacuum extraction ([[Chignon (medical term)|chignon]]). The effects were gone a week later.
|  ICD10       =
|  ICD9        = {{ICD9proc|72.7}}
|  MeshID      =
|  OPS301      =
|  OtherCodes  =
|  HCPCSlevel2 =
}}

'''Vacuum extraction''' ('''VE'''), also known as '''ventouse''', is a method to assist delivery of a baby using a [[vacuum]] device. It is used in the second stage of [[childbirth|labor]] if it has not progressed adequately. It may be an alternative to a [[forceps in childbirth|forceps delivery]] and [[caesarean section]].  It cannot be used when the baby is in the [[breech birth|breech position]] or for [[premature birth]]s.  The use of VE is generally safe, but it can occasionally have negative effects on either the mother or the child.<ref name=EMed271175/> The term ''ventouse'' comes from the French word for "suction cup".

==Medical uses==

There are several indications to use a vacuum extraction to aid delivery:
* Maternal exhaustion
* Prolonged second stage of labor
* Foetal distress in the second stage of labor, generally indicated by changes in the foetal heart-rate (usually measured on a [[cardiotocography|CTG]])
* Maternal illness where prolonged "bearing down" or pushing efforts would be risky (e.g. cardiac conditions, blood pressure, aneurysm, glaucoma). If these conditions are known about before the birth, or are severe, then an elective [[caesarean section]] may be performed.

==Technique==
[[File:Vacuum-assisted Delivery (cropped).png|thumb|Vacuum-assisted delivery]]
[[File:Kiwi-vacuumextractor.jpg|thumb|Kiwi vacuum extractor]]

The woman is placed in the [[lithotomy position]] and assists throughout the process by pushing. A [[suction cup]] is placed onto the head of the baby and the suction draws the skin from the scalp into the cup. Correct placement of the cup directly over the [[flexion point]], about 3&nbsp;cm anterior from the occipital (posterior) [[fontanelle]], is critical to the success of a vacuum extraction.<ref>{{cite book|last=Vacca|first=Aldo|title=Handbook of Vacuum Extraction in Obstetric Practice |edition=3rd |year=2009|publisher=Vacca Research|isbn=978-1-920818-03-6}}</ref> Ventouse devices have handles to allow for traction.  When the baby's head is delivered, the device is detached, allowing the birthing attendant and the mother to complete the delivery of the baby.

For proper use of the ventouse, the maternal [[cervix]] has to be fully dilated, the head engaged in the birth canal, and the head position known. Preferably the operator of the vacuum extractor needs to be experienced in order to safely perform the procedure. The baby should not be [[preterm]], previously exposed to [[scalp sampling]] or failed [[Forceps in childbirth|forceps delivery]].<ref name=EMed271175/> If the ventouse attempt fails, it may be necessary to deliver the infant by forceps or [[caesarean section]].

==History==
In 1849 the [[Edinburgh]] professor of obstetrics [[James Young Simpson]], subsequently known for pioneering the use of [[chloroform]] in childbirth, designed the Air Tractor which consisted of a metal syringe attached to a soft rubber cup.<ref name=EMed271175>{{EMedicine|article|271175|Vacuum Extraction}}</ref>  This was the earliest known vacuum extractor to assist childbirth but it did not become popular.<ref name=BBCVenema>{{cite web | url=https://www.bbc.co.uk/news/magazine-25137800 | title=Odon childbirth device: Car mechanic uncorks a revolution | first=Vibeke | last= Venema | publisher=BBC World Service | date=3 December 2013 | access-date=2013-12-04}}</ref> Swedish professor Tage Malmstrom developed the ventouse, or Malmstrom extractor in the 1950s. Originally made with a metal cap, new materials such as plastics and siliconised rubber have improved the design so that it is now used more than forceps.<ref name=BBCVenema /><ref>{{cite journal |vauthors=Goordyal D, Anderson J, Alazmani A, Culmer P |title=An engineering perspective of vacuum assisted delivery devices in obstetrics: A review |journal=Proc Inst Mech Eng H |volume=235 |issue=1 |pages=3–16 |date=January 2021 |pmid=32928047 |pmc=7780266 |doi=10.1177/0954411920956467 }}</ref>

Vacuum delivery as a percentage of vaginal births vary depending on location. In the USA they comprise about 10% to 15% of vaginal births while in Italy 4.8% of vaginal births were delivered via vacuum in 2013.<ref>{{cite journal |vauthors=Svelato A, Carabaneanu A, Sergiampietri C, Mannella P, D'Avino S, De Luca C, Bartolone M, Angioli R, Ragusa A |title="To get the baby out off the hook": a prospective, longitudinal, multicenter, observational study about decision making in vacuum-assisted operative vaginal delivery |journal=BMC Pregnancy Childbirth |volume=22 |issue=1 |pages=128 |date=February 2022 |pmid=35172781 |pmc=8848824 |doi=10.1186/s12884-022-04440-5 |doi-access=free }}</ref>

==Comparisons to other forms of assisted delivery==

===Positive aspects===
* An [[episiotomy]] may not be required.
* The mother still takes an active role in the birth.
* No special [[anesthesia]] is required.
* There is less potential for maternal trauma compared to forceps and caesarean section.

===Negative aspects===
* The baby will be left with a temporary lump on its head, known as a [[chignon (medical term)|chignon]].
* There is a possibility of [[cephalohematoma]] formation, or [[subgaleal hemorrhage]] which can be life-threatening.
* There is a higher risk of failure to deliver the baby than with forceps, and an increased likelihood of perineal trauma.<ref>{{Cite journal|last1=Verma|first1=Ganga L.|last2=Spalding|first2=Jessica J.|last3=Wilkinson|first3=Marc D.|last4=Hofmeyr|first4=G. Justus|last5=Vannevel|first5=Valerie|last6=O'Mahony|first6=Fidelma|date=2021 |title=Instruments for assisted vaginal birth|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=9 |pages=CD005455|doi=10.1002/14651858.CD005455.pub3 |pmc=8462579|pmid=34559884}}</ref>

==See also==
* [[Odón device]]

==References==
{{Reflist}}

{{Obstetrical procedures}}
{{Authority control}}

[[Category:Childbirth]]
[[Category:Medical equipment]]
[[Category:Obstetrical procedures]]