Vacuum extraction: is there any need to improve the current training in the UK?

Abstract

Objective. The objective of this study was to assess the use and efficacy of delivery by vacuum extraction or ventouse in routine clinical practice and to assess some aspects of the procedure that may reflect the quality of training in this technique. Materials and methods. Women's demographic profiles and delivery details were collected in both the prospective (B) and retrospective (A) arm of the study. In addition, in the prospective arm of the study two custom-designed forms were used: the obstetrician recorded their perception of where the vacuum cup had been placed on one form while on a second form the pediatrician indicated the actual site of the cup placement as observed from the position of the chignon. All the diagrams of cup placement were reviewed by one of the authors, who was blinded to the outcome of the procedure. Results. The vacuum extractor was the first instrument to be used in 79% and 87% of the instrumental deliveries in groups A and B, respectively, with corresponding failure rates of 20% and 21%. Although an occipito-posterior position was diagnosed in 11% of cases of group A and 14% of cases of group B, the specifically designed occipito-posterior cup was not used at all. The vacuum cup was considered to have been applied suboptimally in 40% of the cases where attempted vacuum delivery failed. Conclusion. The high rate of inappropriate positioning of the cup may reflect difficulty in accurately applying the cup, perhaps due to caput or malposition, but may also represent poor assessment of the orientation and position of the fetal skull and therefore be indicative of a need for improvement in training methods.

Courbe d’apprentissage de la ventouse obstétricale par les internes : étude préliminaire

“…Parmi les différents outils d'extraction, on constate depuis quelques années une nette préférence pour la ventouse par rapport au forceps [12][13][14][15][16]. Comme le soulignent O'Grady et al [15], la popularité de la ventouse est essentiellement liée à sa réputation d'un apprentissage facile et d'une faible morbidité maternelle.…”

“…Le respect des règles de base de la technique de ventouse et leur maîtrise sont donc les conditions sine qua non pour limiter l'incidence des complications foetales et maternelles. Dans l'étude de Sau et al [14], l'adresse et l'expérience de l'opérateur apparaissaient comme des facteurs importants dans la réussite d'une extraction instrumentale. O' Grady et al estiment qu'« une tentative d'extraction instrumentale, au décours d'une épreuve raisonnée de voie basse, n'est envisageable qu'entre des mains entraî-nées, si les chances de succès sont considérées élevées, et que tout est prêt pour une césarienne potentielle » [15].…”

Analysis of Ventouse Deliveries at Tertiary Care Teaching Hospital

“…Thus, methods to achieve, evaluate and maintain competency in assisted vaginal delivery need to be addressed. A high rate of inap-propriate placement of the vacuum cup has been cited as a reason for re-addressing training needs 24 . Improved safety for mother and baby has been reported following formal postgradu-ate education and training on assisted birth 25 .…”

Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births

“…Failure rates of instrumental vaginal delivery ranging from 16% to 20% have been reported (Cheong 2004;Sau 2004). Immediate caesarean section without trial of instrumental vaginal delivery would increase caesarean section rate through performing caesarean section in women who could have had a successful trial of instrumental vaginal delivery.…”