Complications of operative vaginal delivery (vacuum) Vacuum
Authors: Alexa Scarcello Reviewers: Claire Lothian, Crystal Liu, Yan Yu*, Ron Cusano* * MD at time of publication
Maternal trauma to surrounding structures to fit operative device
Traction and torsion on flexion point of fetal head, between anterior and posterior fontanelles
Pressure of device directly on fetal scalp
Pop-offs of vacuum cup
Rapid decompression and compression forces
Separation of underlying structures
Bleeding between skull and periosteom of neonate
Cephalohematoma
↑ breakdown of RBCs
↑ release of hemoglobin
Hemoglobin breakdown à↑ release of bilirubin into the bloodstream
Potential interference with spontaneous rotation of trunk
↑ risk of shoulder dystocia
Delivery during shoulder dystocia may traumatize infant’s shoulder
Brachial plexus injury
Head injury leads to potential ocular trauma
Retinal hemorrhage
Hyperbilirubinemia
Fetal scalp lacerations
Tentorial tears
Intracranial bleeding
Perineal lacerations
1° Lacerations: skin, subcutaneous tissue, vaginal epithelium 2° Lacerations: into superficial perineal muscles
3° Lacerations: extending to rectal sphincter
4° Lacerations: extending to rectal mucosa
Urethral injury
Rupture of emissary veins (connections between dural sinus and scalp veins)
Blood accumulation between epicranial aponeurosis and periosteom
Subgaleal hemorrhage
Large space in between these tissue layers ↑ capacity for blood accumulation here
Hypovolemia Death
Factors independent of operative device
Notes:
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Vacuums are now used more often (compared to forceps) due to ↓ maternal trauma
Caution in use if fetus <34wks Jaundice Less operator experience Higher fetal station Poor head Rotation Longer active 2nd stage ↑ complication rate Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Aug 4, 2019 on www.thecalgaryguide.com