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External Cephalic Version: Is it an Effective and Safe Procedure?
Published on: June 6, 2020
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Obstetric management in vacuum-extraction deliveries
Mia Ahlberg1, Sissel Saltvedt2, Cecilia Ekéus1
1Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Summary
Vacuum extraction (VE) deliveries were mostly managed safely, though some cases exceeded recommended pulls or duration. Adherence to clinical guidelines for VE varied, with some units having incomplete best practices.
Area of Science:
- Obstetrics
- Gynecology
- Maternal-Fetal Medicine
Background:
- Vacuum extraction (VE) is a common obstetric procedure for assisted vaginal delivery.
- Standardized clinical guidelines aim to ensure safe VE practices.
- Variations in VE management can impact maternal and fetal outcomes.
Purpose of the Study:
- To describe obstetric management during vacuum extraction (VE) deliveries.
- To compare VE practices against existing clinical guidelines.
- To identify areas for improvement in VE protocols.
Main Methods:
- Observational study of 600 vacuum extraction (VE) cases from six Swedish delivery units in 2013.
- Collection of unit-specific clinical VE guidelines for comparative analysis.
- Detailed data recording on VE procedure parameters and management.
Main Results:
- 93% of VE procedures resulted in vaginal delivery; 7% required conversion to cesarean section.
- 14.6% of cases experienced cup detachment; 11% utilized fundal pressure.
- Exceeding 20 minutes extraction time occurred in 2.3%; >6 pulls used in 6% of cases.
- Fetal station above ischial spines noted in 2.3% of deliveries.
- Clinical VE guidelines varied and were often incomplete.
Conclusions:
- Most vacuum extractions (VE) align with safety recommendations.
- Occasional disregard for safety rules noted, including excessive pulls or duration.
- Inconsistent clinical guidelines highlight a need for standardization in VE management.
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