Ventouse extraction, also known as vacuum-assisted vaginal delivery, is a procedure used to assist the birth of a baby when labor is prolonged or complications arise during the second stage. It involves using a suction cup device (ventouse) attached to the baby’s head to help guide them out of the birth canal while the mother pushes.
Definition
Assisting in the delivery of a fetus presenting by vertex using an instrument called Ventouse or vacuum extractor.
Indications for Ventouse extraction
- As an alternative to forceps delivery.
- As an alternative to rotational forceps as in occipitotransverse or occipitoposterior position.
- Delay in descent of the head in case of second baby of twins.
- Delay in late first stage or second stage of labor.
- Maternal exhaustion.
- Mild fetal distress.
Contraindications
- Any presentation other than vertex (face, brow, breech).
- Preterm fetus (<34 weeks).
- Chance of scalp avulsion or subaponeurotic hemorrhage.
- Suspected fetal coagulation disorder.
- Suspected fetal macrosomia (>4 kg).
Conditions to be fulfilled
- There should not be any bony resistance below the level of head.
- The head of a singleton baby should be engaged.
- Cervix should be at least 6 cm dilated.
Equipment’s
- Suction cups of varying sizes (30,40,50, and 60 mm).
- A vacuum generator.
- Traction tubing and handle.
- Delivery pack containing:
- Artery forceps
- Dissecting forceps
- Cord clamp
- Episiotomy scissors
- Suture needle and suture material
- Vaginal tampon
- Mucous sucker.
- Neonatal resuscitation equipment.
- Emergency drugs.
Procedure
| Nursing action | Rationale | |
| 1. | Explain procedure to mother and family. | Helps in obtaining cooperation of family and mother. |
| 2. | Obtain informed consent from mother. | Prevents litigation. |
| 3. | Instruct mother to empty the bladder, if not possible, catheterization should be done. | To avoid injury to urinary bladder. |
| 4. | Ensure that bowel is empty. | For smooth passage of fetal head. |
| 5. | Maintain lithotomy position and start an IV line. | Promotes safe procedure. |
| 6. | Assess FHR frequently. | To ensure fetal health status. |
| 7. | Assess for descent of fetal head with mother’s uterine contraction. | To monitor progress of labor. |
| 8. | Infiltrate perineum with 1% lignocaine. | Acts as a local anesthetic. |
| 9. | Perform episiotomy when the contractions are strong. | Provides sufficient space for applying vacuum cup. |
| 10. | Assist obstetrician in applying suction cup and traction, and maintaining of pressure. | |
| 11. | As soon as the head is delivered, the vacuum is reduced by opening the screw-release valve. | Aids in release of the cup. |
| 12. | Complete the delivery of the fetus in the normal manner. | |
| 13. | Repair the episiotomy in the usual manner. | |
| 14. | Clean the perineum and check for bleeding or laceration. | |
| 15. | Record the date, time, pressure and traction applied, and any complication in nurses’ record. | Acts as a communication between staff members. |
Complications
Fetal Complications
- Superficial scalp abrasion.
- Sloughing of the scalp.
- Cephalhematoma.
- Subaponeurotic hemorrhage.
- Intracranial hemorrhage.
- Retinal hemorrhage.
- “Chignon” formation.
Maternal Complication
Injuries are uncommon but may occur due to inclusion of the soft tissues, such as the cervix or vaginal wall inside the cup.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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