A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear t o predispose t o an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed t o address this still open question more rigorously.

Safety recommendations for vacuum-assisted delivery focus on limiting the number of pulls and the duration of the procedure. With the introduction of the Kiwi OmniCup vacuum extractor incorporating a Traction Force Indicator, it is now possible to reliably monitor and control the amount of traction force exerted on the fetal scalp. The OmniCup was used in a prospective observational study of 119 vacuum-assisted deliveries in nulliparous women to establish practical guidelines for safe practice in typical clinical settings.

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