[The procedure to be adopted in cases of breech presentation: use of the vacuum extractor]

The authors review the advantages of a non-standard method of extraction in cases of breech presentation, the vacuum extractor. This method should not only replace total extraction in cases of frank breech, but should also find much wider applications. In fact the technique, which is easily applied and always effective, permits extraction in cases of frank breech by the vaccum cup at the stage of complete dilatation, preferably when the breech is well engaged, without serious complications. The authors then explain how they have used the vacuum extractor in their general practice in cases of breech presentation: in 100 cases, the extractor was used 41 times, total extraction was used 19 times, caesarian section, 18 times, partial extraction 9 times, and there was no intervention in 9 cases some of which were terminated by the Mauriceau method. The corrected mortality was 1% and the corrected morbidity with an Apgar score of less than or equal to 6 et 1 minute, was 16.3 percent (excluding premature infants of less than 1,500 g and malformed infants). The use of the total extraction principle and particularly of the vacuum extractor avoids the occurrence of the unexpected and the necessity for the obstetrician to improvize a more difficult and perilous method of rescue.