We will talk about vacuum extraction of the fetus, as well as the consequences of this procedure.

During my pregnancy, at all the ultrasounds, the doctor said that the baby had a big head, but all the relatives were big-headed, so I wasn’t particularly worried about this. My gynecologist wasn’t worried either, my pelvis was wide, I gave birth normally.

At 40 weeks and 2 days, contractions began at 6 o’clock in the evening, by 12 o’clock at night the interval was already 5 minutes and it was decided to go to the maternity hospital. In the maternity hospital, an examination, all the accompanying procedures, and now I’m already in the maternity ward. The opening was slow and painful, they numbed the pain with no-shpa, but other than a terrible taste in the mouth, there was no use.

At 11 am the next day they decided to pierce the bladder, but it successfully burst on its own, the waters were green, a CTG was not taken, terrible pain and the inability to even move due to the sensors on the stomach. As luck would have it, I gave birth on New Year's holidays, there was only one team, but there were many women in labor. The midwife showed me how to breathe correctly to push the baby to the exit, which is what I did for the next few hours.

Closer to 5 pm, everyone realized that everything was useless, no matter how hard I tried, my baby just didn’t want to be born. After my heartbeat began to worsen, a crowd of doctors gathered around me and it was decided to do something with me, since the baby’s head was stuck in the birth canal and it was too late to do a cesarean section.

At first they tried to persuade me to try harder, but almost a day without sleep and the hellish pain exhausted me so much that I no longer had any strength and the contractions weakened. It was decided to make an incision and vacuum extraction.

I heard about this method, but I never thought that I would try it on myself. I won’t go into details; you can find a lot of information on the Internet. As a result, they did an episiotomy and pulled out the head with a suction cup, while another doctor pressed on top of my stomach, fortunately the head was almost out and I didn’t have to pull too hard. I didn’t even feel any manipulation, everything was done during the contraction, and then it was no longer clear what and where it hurt. On the second push, my baby was born. Weighing 3240 and head circumference 36 cm. Apgar score 7/8. At first the neonatologists said 8/8, but the gynecologist was indignant: “What are you talking about, the waters there were like a swamp!”

When they showed me my baby, I began to cry out loud and ask him for forgiveness that I could not give birth to him normally.

The first days the child’s head was elongated like a zucchini, a bruise on the top of the head reminded of a vacuum, but by discharge it had almost disappeared. On the 2nd day they did an ultrasound and reported that there were no consequences.

In the first months, the hypoxia he suffered also made itself felt; the baby cried a lot and did not allow him to touch his head.

Because of all the worries, my milk naturally disappeared and I practically began to hate myself, I couldn’t give birth, I also can’t feed, what kind of mother am I? Most likely, postpartum depression is to blame.

Now the child is almost 10 months old, developing normally, everything is appropriate for his age, but over time problems are revealed. As the head grew, deformation of the skull became noticeable, as it was subjected to great pressure during childbirth, and the ensuing neurological problems, such as excitability, poor sleep, hypertonicity, etc. We have already completed 4 courses of massage and are undergoing treatment with an osteopath. The prognosis is good, the main thing is to study and not leave it to chance.

Of course, I wouldn’t wish anyone to experience this, but childbirth is an unpredictable process and anything can happen, the main thing is not to waste time and be sure to see the child with experienced doctors, of whom, unfortunately, there are fewer and fewer in our time, since such births are not without consequences pass.

To everyone who is expecting an easy birth and healthy babies!

What is vacuum fetal extraction?

Vacuum-assisted childbirth, what is it?

In the process of weak labor, when the efforts of the woman in labor do not bring the desired result due to weak contractions and pushing, they resort to the use of a special vacuum apparatus. Why is this necessary? For various reasons (we will look at them a little later), the mother in labor needs urgent assistance in pushing out the baby. And the vacuum extractor actually helps to pull the baby out of the birth canal.

The device operates as follows: a cup of vacuum is inserted into the vagina and leaned against the head, then pressure is created, which pulls the belly out. However, the consequences can be very unpleasant and sad for the child, so this procedure is resorted to in extreme cases, and then only by doctors with extensive experience behind them. Often, the vacuum aspiration method is also used in cases of frozen pregnancy or spontaneous miscarriage, in order to extract the fertilized egg.

Indications for childbirth using a vacuum

Agree, if the risks of complications are so high, then the use of a vacuum should be justified. What indications force doctors and obstetricians to resort to such a serious method?

• acute oxygen starvation of the baby;
• a sharp decrease in the baby’s heart rate;
• endometritis;
• weak labor, which cannot be stimulated with medication (for example, with oxytocin).

If a woman cannot strain and push too much for any reason (problems with the cardiovascular system, increased eye pressure, etc.), then it is indicated. This is why it is so important to warn your gynecologist in advance about various features and problems. your body, as well as visit specialists to decide on the method of delivery. If the doctor insists on performing a caesarean section, there is no need to refuse, because no one is simply offered to go under the knife. This means that due to problems in your body, labor may be difficult, and therefore you will have to resort to various types of stimulation and manual assistance, in particular, to the vacuum method of extraction, which is much worse than cesarean.

Pros and Cons of Vacuum Extraction

What conditions allow the baby to be pulled out using a vacuum?

• live baby;
• full-term pregnancy;
• the size of the head does not exceed the size of the pelvis;
• the fetal head sank into the pelvis;
• the woman is conscious, her mind is not clouded, she is able to follow the doctor’s commands.

Only if absolutely all conditions are met is it possible to use such a radical method of pulling out the crumbs. If even one point does not correspond to your situation, then using vacuum extraction is PROHIBITED!

What are the contraindications for this procedure?

• • inability to push;
  • early birth;
  • the child walks not with his head, but with his buttocks, or incorrect cephalic presentation;
  • the size of the head does not correspond to the size of the pelvis;
  • insufficient dilation (less than 10 cm);
  • stillbirth.

Consequences

Often, during this mini-operation, the cup slips off the child’s head, which can lead to injury to the tiny head and the development of complications. However, complications can arise even with a perfectly performed procedure!

What could be the consequences for a child when using such an unsafe method of delivery, if even the doctors themselves try to resort to this procedure in extremely rare cases in the absence of the possibility of performing another, safer method of pulling the baby?

The consequences can be of moderate severity:

• • • scalp damage;
    • jaundice;
    • hemorrhage of blood vessels in the eyes.

And extremely difficult:

• • • cephalohematoma;
    • intracranial pressure;
    • facial deformities;
    • epilepsy;
    • injury to the brain or spinal cord;
    • various neurological diseases;
    • convulsions;
    • delayed emotional and/or psychological development;
    • various damage to the nervous system;

Very often, after vacuum extraction, a hematoma appears in the back of the baby’s head, which resolves on its own and does not cause any harm to the development and vital functions of the baby. But this is the most positive scenario for the development of events. Statistics show that complications occur in approximately half of cases. Therefore, such interference in the birth process, even if for a good purpose, should be very well weighed.

Consequences for mom:

• • • various types of ruptures (birth canal, perineum);
    • development of infections;
    • increasing the postpartum recovery period;
    • deformation of the external genitalia.

Many women report experiencing this type of delivery.

Dear readers, everyone wants every child in this world to be healthy and have the opportunity to enjoy life, don’t they? That is why you need to be very careful about planning and carrying a pregnancy, as well as delivery. Therefore, if you know about your health problems that may interfere with the normal process of childbirth, then you need to discuss this with your doctor in advance.

I really hope that each of you will be a happy mother of a healthy and cheeky toddler. Health to you and your little ones! All the best! See you!

A vacuum can be used during and after childbirth if women have impaired contractile function of the uterus. These are completely different manipulations.

The purpose of vacuum extraction is to extract a living fetus when a caesarean section is not possible at this stage. The apparatus for exposure during childbirth consists of a buffer tank equipped with a pressure gauge, a hand pump and a set of applicators of various sizes.

Currently, there are several modifications of such devices: E.V. Chachava, Malstrom and P.D. Vashakidze. The bowls of the Maelstrom apparatus are made of metal; other designers proposed rubber for the manufacture of bowls.

A postpartum vacuum device consists of a syringe with a catheter, which is attached to a machine or hand pump that creates negative pressure in the uterine cavity.

Childbirth using a vacuum and vacuum cleaning after childbirth are completely different manipulations. In the first case, this is extraction of the fetus, in the second, curettage.

Vacuum birth

Unlike applying forceps, it is impossible to perform a vacuum effect during childbirth without the participation of the woman in labor.

Indications for this procedure:

• acute hypoxia in the fetus when it is already in the birth canal;
• weak labor activity that cannot be corrected with the help of medications;
• cessation of contractions and pushing during the movement of the fetus through the birth canal.

Vacuum extraction is carried out according to the following algorithm.

1. A catheter with anesthesia is inserted into the bladder of a conscious woman in labor;
2. At the same time, the birth canal is examined;
3. Further, a lot depends on the qualifications of the obstetrician. He should touch, having opened the entrance to the birth canal, place the cup of the device on the child’s head with one hand, holding the entrance to the vagina with the other;
4. At this time, the doctor, using a hand pump or a mechanical device - the latter is used quite rarely to avoid unnecessary injuries - creates negative pressure.

The woman in labor begins to push on command, helping to pull out the fetus with the extractor.

Contraindications for vacuum extraction of the fetus are:

• late gestosis;
• heart defects in the stage of decompensation;
• arterial hypertension;
• high myopia;
• extension presentation of the fetal head;
• childbirth before 36 weeks;
• discrepancy between the sizes of the fetal head and the mother's pelvis.

Incorrect placement of the cup on the fetal head, which causes compression of the large fontanel, can cause quite serious consequences.

Childbirth with a vacuum - possible consequences for the child

Currently, they try to resort to vacuum extraction only in extreme cases, prescribing a caesarean section if the possibility of complicated labor is possible.

The consequences of childbirth with a vacuum are most often damage to the nervous system - in 60% of cases, the appearance of a neurological syndrome - obstetric paralysis or tetraparesis - in 23.7% of newborns. In 1 case out of 5, brain injuries are diagnosed.

After using vacuum assisted delivery, hematomas remain on the baby’s head. If the seal is broken, the cup may slip off the fetal head.

The invention of a vacuum device was once declared an obstetric breakthrough - it seemed that this method was the most gentle compared to the application of forceps. It seemed that even inexperienced obstetricians could manage without injuries. As it turned out, this method is no better than time-tested forceps, and no less traumatic.

How can you answer the question: “Which birth is better, cesarean or vacuum?” The method is chosen by the doctor, depending on the clinical picture. Vacuum extraction is not an operation, it is obstetric care in a critical case. Manipulations help save the life of the baby and mother if medications and other methods cannot be used.

Vacuum aspiration

The health status of the postpartum mother largely depends on how the 3rd stage of labor went – ​​separation of the placenta. The remnants of the fetal membrane are subsequently expelled using natural uterine contractions.

If contractions are not intense enough, then blood flow slows down, foreign tissue inclusions remaining in the uterus form a favorable nutrient medium for the active development of pathogenic microorganisms that cause purulent-inflammatory processes.

Remains of foreign tissue and accumulated clots prevent the uterus from contracting, which can provoke the development of serious diseases - for example, endometritis.

On days 3-5 after childbirth - nowadays this is more often done before discharge from the hospital - the mother in labor undergoes an ultrasound examination, which determines the condition of the uterine cavity. Some 20-25 years ago, the examination was carried out on a chair, but with the help of ultrasound it is much more accurate to describe the clinical picture.

If there are foreign tissues in the uterine cavity, cleaning is prescribed. The doctor decides which methods will be chosen for curettage.

Vacuum cleaning – compared to manual cleaning – is considered the most gentle procedure. However, it is not carried out if a woman has malformations of the uterus or neoplasms, gynecological infections, or if curettage was performed before pregnancy - regardless of the reasons for the surgical intervention.

How does vacuum aspiration work?

The procedure can be performed manually or using hardware. In the first case, the doctor creates negative pressure in the uterine cavity using a hand pump, in the second, a syringe with a catheter is connected to an electric pump.

Cleaning after childbirth is technically no different from a conventional vacuum operation.

The woman is placed on a gynecological chair, and the external genitalia are treated with an antiseptic solution.

A speculum is inserted into the vagina and a preoperative examination is performed. At this stage, intravenous or intrauterine anesthesia is usually administered, since the installation of bullet forceps and a dilator causes severe pain.

Then the cervix and upper lips are fixed with bullet forceps, and a probe is inserted into the cavity to determine the internal dimensions of the uterus.

Vacuum extraction of the fetus (Latin vacuum - emptiness; extrahere - to pull out) is an obstetric delivery operation of extracting a living fetus during childbirth using a special device - a vacuum extractor, the cup of which is sucked to the presenting part of the fetus (head) due to rarefaction of air.

In our country, vacuum extraction is used in 0.12-0.20% of all births, and recently its use has become increasingly rare. The low percentage of vacuum extraction is explained by the expansion of indications for cesarean section in the interests of the fetus.

Malmstrom vacuum extractor device (Fig. 25.34a). The device is equipped with a set (7 pieces) of metal cups (caps), varying in diameter (from 15 to 60 mm). To extract the head of a full-term fetus, three large cups (40-60 mm in diameter) with a rounded smooth edge and a concave inner surface are usually used. There is a hole in the center of the cup, covered with a thin metal plate that does not cover the hole. A chain passed through a rubber tube is attached to the plate. The chain connects the cup to a metal tap that serves to secure the chain. There is a device with a vacuum gauge to create negative pressure.

It is most advisable to use large elastic (silicone, rubber) cups, which are less traumatic for the fetus and the mother.

To create a vacuum, devices with adjustable negative pressure have now been created (Fig. 25.34.6).

Indications for applying a vacuum extractor. Indications for vacuum extraction are:

1) weakness of labor, not amenable to drug therapy;

2) low transverse position of the swept seam;

3) the onset of acute fetal hypoxia.

The conditions for applying a vacuum extractor are:

1. Live fruit.

2. Full opening of the uterine os.

3. Absence of amniotic sac.

4. The location of the fetal head in a wide or narrow part of the pelvic cavity.

5. Correspondence between the size of the pelvis and the fetal head.

6. Accurate knowledge of the topographic relationships in the small pelvis at the time of application of the vacuum extractor.

7. Empty bladder.

Contraindications to applying a vacuum extractor are as follows:

1. Dead fetus.

2. Incomplete opening of the uterine os.

3. Hydrocephalus, anencephaly.

4. Extended presentation and high straight position of the sagittal suture.

5. Anatomically (II-III degree of narrowing) and clinically narrow pelvis.

6. Very premature fetus.

7. High position of the head (pressed, standing as a small or large segment at the entrance to the pelvis).

8. Diseases of the mother that require stopping pushing (preeclampsia, preeclampsia, eclampsia, hypertension, heart defects with symptoms of decompensation, etc.).

Preparing for surgery. Preparation is the same as for all vaginal surgeries.

Rice. 25.34.

A - appearance; b - diagram

Before surgery, the bladder is emptied using an elastic catheter. Inhalation and intravenous anesthesia are contraindicated, since the woman in labor must push during extraction. For pain relief, especially in primigravidas, bilateral novocaine anesthesia of the pudendal nerves is indicated, which also helps to relax the perineal muscles. Immediately before the operation, a vaginal examination is performed to clarify the obstetric situation.

When applying a vacuum extractor, the presence of an assistant, the presence of an anesthesiologist and a neonatologist proficient in neonatal resuscitation techniques are required.

Operation technique. With the right hand, under the control of the fingers of the left hand, a cup No. 5-7 is inserted into the vagina with the side side, depending on the capacity of the vagina and the height of the perineum. It is very important to correctly fix the cup on the fetal head. Attachment of the cup in the area of ​​the small fontanel promotes flexion of the head and the correct mechanism of labor. The location of the cup on the border between the small and large fontanel promotes extension during traction. When the cup is fixed to the side of the sagittal suture, asynclitic insertion of the head occurs (Fig. 25.35).

Rice. 25.35..

A - types of fixation: 1 - flexion (ideal), 2 - extension, 3 - paramedial; b - localization of the vacuum extractor cup on the fetal head: 1 - in the area of ​​the small fontanel, 2 - in the area of ​​the posterior corner of the large fontanel; 3 - paramedian location for asynclitism.

After the cup is brought to the head, you need to make sure that the edges of the cervix or the vaginal wall are not captured, then you should press the cup to the head. An assistant connects the hoses from the cup and the vacuum apparatus and slowly (over 2-4 minutes) using a hand pump or a special apparatus creates a negative pressure of 520 mmHg. Art. (0.7-0.8 kg/cm2). In this case, under the cap of the cup, a birth tumor (“chignon”) is formed on the head, due to which the cup is held. Creating a vacuum too quickly can cause the formation of a cephalohematoma.

After creating a vacuum, you should once again check that the vacuum extractor cup is positioned correctly on the head. After making sure that the cup is applied correctly, proceed to traction. The obstetrician places his fingers on the rubber hose directly at the cup itself (sometimes at a distance) and performs traction synchronously with pushing, according to the pelvic axis and the mechanism of labor (Fig. 25.36, 25.37). If the traction is directed incorrectly, the cup can come off and cause serious injury to the woman in labor. During traction, you can rotate the head in the desired direction.

Before cutting through the parietal tuberosities, the perineum should be dissected (mid-lateral episiotomy). When erupting the parietal tubercles, the calyx is separated from the head after the vacuum is eliminated. Then the head is removed manually. The duration of the operation should not exceed 15-20 minutes, as the risk of bruising, cephalhematoma formation, and brain injury increases.

If the cup slips, it cannot be repositioned more than 2 times due to the high traumatic risk for the fetus. Slipping of the cup usually indicates an incorrect choice of delivery method. If the head is located high enough, it is sometimes necessary to resort to a caesarean section. If it is in the pelvic cavity, it is necessary to apply forceps.

Ineffectiveness of vacuum extraction is observed in 1-27% of cases.

After the operation of applying a vacuum extractor, especially if the operation was difficult, manual separation of the placenta and a control examination of the walls of the uterus to determine its integrity are indicated. In all cases, after vacuum extraction of the fetus, an examination of the cervix and vagina using speculum is indicated, and if their integrity is damaged, sutures are necessary.

Rice. 25.36.

(a) and the beginning of traction (b)

Rice. 25.37..

To prevent bleeding in the afterbirth and early postpartum periods, intravenous administration of uterotonic agents (methylergometrine, oxytocin) is necessary.

Complications. Complications during a vacuum extraction operation can be observed on the part of both the mother (ruptures of the perineum, vagina, labia minora and majora, clitoris, cervix and rarely rupture of the lower segment of the uterus, bladder, symphysis) and the fetus (abrasions and wounds on the head, cephalohematomas, intracranial hemorrhages, etc.).

When a vacuum extractor is applied due to fetal hypoxia, 20.2% of children subsequently experience dysfunction of the central nervous system. A connection has been established between such disorders and the duration of vacuum extraction and the severity of asphyxia before surgery.