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Skull fracture caused by vacuum extraction

K Hickey1, P McKenna

  • 1Rotunda Hospital, Dublin, Ireland.

Obstetrics and Gynecology
|October 1, 1996
PubMed
Summary

Vacuum extractor use in assisted vaginal delivery may cause fetal skull fractures. While this infant recovered neurologically, the risk of fracture may be underestimated in routine practice.

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Pediatric Surgery

Background:

  • Assisted vaginal delivery increasingly utilizes vacuum extractors.
  • A common belief suggests vacuum cups detach before causing significant fetal harm.

Observation:

  • A term infant underwent rotational delivery using a vacuum extractor with a 6-cm metal cup applied paramedially for 12 minutes.
  • Vacuum pressure was 0.8 kg/cm2, with four traction efforts needed for delivery.
  • A subsequent neonatal skull X-ray revealed a comminuted parietal bone fracture at the cup site.

Findings:

  • The vacuum extractor can exert substantial traction force.
  • Fetal skull fractures, specifically parietal bone fractures, are a potential complication.
  • The actual incidence of vacuum extractor-related fractures may be higher than reported.

Implications:

  • Clinical vigilance is necessary during vacuum-assisted deliveries.
  • The potential for fetal skull fracture should be considered, even with seemingly normal outcomes.
  • Further research is warranted to determine the true incidence of neonatal fractures from vacuum extraction.

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