[High vacuum extraction: justifiably obsolete in view of the risks to the infant]

The author was asked to provide an expert assessment of the case histories of 28 patients delivered by vacuum extraction. At the start of the extraction the foetal head level was at station 0 or above in 25 of the patients. In 12 cases the duration of extraction exceeded 14 min and in 7 of the cases it exceeded 19 minutes with a maximum of 45 minutes. Nine of the infants died, 11 suffered cerebral damage, 4 had brachial plexus injury and 1 had both cerebral damage and plexus injury. In 17 cases a causal relation between the unfavourable outcome and the vacuum extraction seemed plausible. During the past 40 years several studies of patients who have undergone high pelvic vacuum extractions have been published; cerebral damage of the infants often occurred. The risk of shoulder dystocia resulting in brachial plexus injury is considerably increased in case of a large infant and mid pelvic or high pelvic delivery. In the paediatric literature a number of authors describe cerebral lesions caused by high pelvic vacuum extraction. High pelvic vacuum extraction is still occasionally practiced in the Netherlands; it is a hazardous technique and should be replaced by caesarean section.