[CNGOF statement on instrumental vaginal deliveries using vacuum extraction]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Safety

Background:

• Instrumental delivery, including vacuum extraction, is utilized to expedite the expulsive phase of labor, especially during fetal heart rate deceleration.
• The choice of instrument (vacuum, forceps, spatulas) depends on clinical context and operator expertise.
• In France, instrumental assistance is used in approximately 12% of births, with vacuum extraction employed in about two-thirds of these cases.

Purpose of the Study:

• To review the safety and efficacy of obstetric vacuum extraction.
• To compare vacuum extraction with forceps delivery and cesarean section.
• To assess maternal and neonatal outcomes associated with vacuum-assisted vaginal delivery.

Main Methods:

• Review of safety data for obstetric vacuum extraction by the Obstetrics Committee of the CNGOF.
• Analysis of epidemiological studies on instrumental delivery rates and outcomes.
• Comparison of maternal and neonatal complication rates between vacuum extraction, forceps, and cesarean delivery.

Main Results:

• Vacuum extraction is a safe method with rare maternal (perineal trauma, hemorrhage) and neonatal (intracranial hemorrhage) complications, comparable to laboring cesarean sections.
• Compared to forceps, vacuum extraction shows reduced maternal morbidity (e.g., anal sphincter injury) with similar neonatal outcomes, barring a slight increase in cephalohematoma or jaundice.
• Operator experience does not influence outcomes.

Conclusions:

• Vacuum-assisted vaginal delivery is a relevant alternative to cesarean section at full cervical dilation.
• This technique is recommended by the CNGOF as part of instrumental delivery options.
• The safety profile supports its continued use in obstetric practice.