[CNGOF statement on instrumental vaginal deliveries using vacuum extraction]

The Obstetrics Committee of the CNGOF, consulted by the CNP GOGM at the request of the ANSM, has reviewed the safety of obstetric vacuum extraction. Instrumental delivery may be performed to shorten the expulsive phase, particularly in cases of fetal heart rate deceleration. The available instruments are the vacuum, forceps, and spatulas, with the choice depending on the clinical situation and the operator. In France, approximately 12% of births involve instrumental assistance, a rate that has remained stable since 2016. The vacuum is used in about two-thirds of these cases - a proportion similar to that observed in most European countries and in Canada, but higher than in the United States. The vacuum works by creating suction on the fetal scalp, allowing controlled and safe traction. Maternal complications (perineal trauma, hemorrhage) and neonatal complications (notably intracranial hemorrhage) are rare and comparable to those observed in cesarean deliveries performed during labor. Epidemiological studies do not show an increased risk of neurological impairment or long-term sequelae in children born by vacuum extraction. Compared with forceps, vacuum extraction is associated with reduced maternal morbidity, particularly a lower risk of anal sphincter injury, with no significant difference in overall neonatal outcomes, except for a slightly higher risk of cephalohematoma or jaundice. No difference has been observed according to operator experience. In conclusion, vacuum-assisted vaginal delivery, which is a technique among the methods recommended by the CNGOF, represents a relevant alternative to cesarean section at full cervical dilation.