Vacuum extraction with all the details .pptx

covers all information that is needed to be known by the reader about vacuum extraction

1. Presented by KENGOZI HARRIET - 2021/U/MMU/BSME/004 Vacuum extraction

2. Introduction Vacuum extraction is a procedure used during childbirth to assist in the delivery of the baby. It involves the use of a vacuum extractor, a suction cup attached to the baby's head, to help guide the baby through the birth canal. This technique is typically used when the mother is having trouble pushing the baby out on her own or when there are concerns for the baby's well-being during delivery

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4. Indications Cervix fully dilated. Membranes previously ruptured. Engagement of the fetal head. The clinician has determined the position of the fetal head. Fetal weight estimation performed previously. Pelvis thought to be adequate for vaginal delivery.

5. Cont. Review for conditions for vacuum extraction; Vertex presentation Term foetus Cervix fully dilated Head at least level with spines and no more than 2/5 above the symphysis pubis

6. Procedures Check all connections and test the vacuum on a gloved hand If necessary, use a pundendal block Assess the position of the head by feeling the sagital suture line and the fontanelles . Identify the posterior fontanelle Apply the largest cup that fit with the centre of the vertex over the flexion point 1cm anterior to the posterior fontenelle

7. Cont. This placement will promote flexion, descent and autorotation with traction. An episiotomy may be needed for proper placement at this time. If an episiotomy is not necessary for placement, delay the episiotomy until the head is stretching the perineum or the perineum interferes with the axis of traction.

8. Use of episiotomy

9. Cont. This will avoid unnecessary blood loss Check the application, ensure there is no maternal soft tissue (cervix or vagina) within the rim . With the pump, create a vacuum of 0.2kg/cm2 Negative pressure and check the application. Increase the vacuum to 0.8kg/cm2 and check the application

10. Cont. After maximum negative pressure, start traction in the line of the pelvis axis and perpendicular to the cup. If the foetal head is tilted to one side or not flexed well, direct traction in a line that will try to correct the tilt or deflection of the head With each contraction, apply traction in a line perpendicular to the plane of the cup rim.

11. Cont. Wearing sterile gloves, place a finger on the scalp next to the cup during traction to assess potential slippage and descent of the vertex Btn contractions; check the fetal heart rate, check the application of the cup.

12. Cont. Never use the cup to actively rotate the baby’s head; rotation the baby’s head will occur with traction The first pulls help to find the proper direction for pulling Do not continue to pull btn contractions and expulsive efforts. With progress and in the absence of foetal distress, continue the guiding pulls for a maximum of 30min

13. Cont. Vacuum extraction has failed if; The fetus is undelivered after three pulls with no descent or after 30min The cup slips off the head twice at the proper direction of pull with a maximum negative pressure. Every application should be considered a trial of vacuum extraction. Do not persist if there is no decent with every pull. If vacuum extraction fails, perform caesarian section.

14. Complications Complications usually result from not observing the conditions of application of traction and from continuing efforts beyond the time limits stated above. Foetal Localized scalp oedema occurs under the vacuum cup, it is harmless and disappears in a few hours.

15. Cont. Cephaloheamatoma requires observation and usually will clear in 3-4 weeks Intracranial bleeding is rare and requires immediate intensive neonatal care. Scalp abrasions (common and harmless) and lacerations may occur. Clean and examine lacerations to determine if sutures are necessary Necrosis is extremely rare.

16. Cont. Maternal Tears of the genital tract may occur Examine the woman carefully and repair any tears of the cervix or vagina or repair episiotomy.

17. Partograph Greek word  meaning ‘labor curve’ A graphic recording of progress of labour and salient features in the mother and fetus. It serves as an early warning system and assists in early decision of transfer, augmentation or termination of labour. Increases the quality and regularity of observations of the fetus and mother in labour.

18. The Principles of WHO Partograph The active phase of labour commences at 3cm cervical dilatation. The latent phase of labour should not last longer than 8 hours. During active labour, the rate of cervical dilatation should not be slower than 1cm/hr. A lag time of 4 hours between a slowing of labour and the need for intervention is unlikely to compromise the fetus or mother and avoids unnecessary intervention. Vaginal examinations should be performed as infrequently as is compatible with safe practice (once in 4 hrs ) Partograph with preset lines.

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21. Components of the Partograph Bio data The progress of labour The fetal condition The maternal condition

22. Bio data Name and Identification Age Gravid Para Antenatal history Medical history Obstetric history

23. P rogress of labour Rate of cervical dilatation of the cervix ( cervicograph) Rate of descent of the presenting part. CERVICOGRAPH is divided into the latent and active phase. Assess cervical dilatation every 4 hours 2 hourly if oxytocin augmentation is ongoing. Cervical dilatation marked with an X

24. Alert line An alert line is a visual representation of a cervical os dilatation rate of 1 cm/hour labor progress sustained throughout the active phase. It is the slowest rate of active phase labor progress for normal labor outcome

25. Action line Drawn 4 hours to the right of the alert line (WHO Partograph) The critical point at which specific management decisions must be made.

26. Descent. The number of fifths of fetal head palpated per abdomen. Plotted on the same graph as the cervical dilatation. Marked with an O or a w

27. Fetal condition Fetal Heart rate: Record every 30 minutes Every 15 minutes in cases of fetal bradycardia or tachycardia Baseline fetal heart rate is 120-160 beats per minute. The amniotic fluid R ecord the colour at every vaginal examination I : membranes intact C : membranes ruptured, clear fluid M : meconium-stained fluid B : blood-stained fluid

28. Moulding Is the overriding of the skull bones when the fetal head passes through the birth canal. An important indication of how adequately the pelvis can accommodate the fetal head. Degrees : Zero : bones apart 1 +: bones touching 2 +: bones overlap, reducible 3 +: overlap, irreducible

29. Maternal condition Pulse Every 30 minutes Blood pressure Every 4 hours Mark with arrows Temperature Every 2-4 hours Urinalysis Every 2-4 hours; for protein, ketones, glucose or blood Measure volume

30. Detecting Poor Progress of Labor Slow Cervical Dilation:  If the rate of cervical dilation is slower than 1 cm per hour during active labor, it may indicate poor progress. Prolonged Labor:  Failure to progress in labor despite adequate uterine contractions and maternal effort can signal poor progress. Fetal Distress:  Abnormalities in fetal heart rate patterns may indicate fetal distress due to inadequate oxygenation, often associated with poor progress in labor. Inadequate Uterine Contractions:  Weak or ineffective contractions can lead to stalled labor progress.

31. Intervention Based on Partograph Findings When poor progress is detected using the partograph, healthcare providers can intervene promptly to prevent complications. Interventions may include: Augmentation of Labor:  Administering oxytocin to strengthen uterine contractions and facilitate cervical dilation. Assisted Vaginal Delivery or Cesarean Section:  In cases of prolonged or arrested labor, assisted delivery methods such as vacuum extraction or forceps delivery, or cesarean section may be necessary. Monitoring and Supportive Care:  Close monitoring of both mother and baby along with supportive care to address any complications that arise.

32. Conclusion Labour is an important human experience, which could give intense joy or sorrow depending on the outcome. It is important for providers of antenatal and intrapartum care to have an understanding of what constitutes normal labour, and to watch out for problems that may arise. The partograph is an inexpensive tool that aids in early recognition of problems with the mother and fetus during labor. All health workers should be conversant with its use.

33. REFERENCES Vannevel V, Swanepoel C, Pattinson RC. Global perspectives on operative vaginal deliveries. Best Pract Res Clin Obstet Gynaecol . 2019 Apr;56:107-113 Baskett TF. Operative vaginal delivery - An historical perspective. Best Pract Res Clin Obstet Gynaecol . 2019 Apr;56:3-10 . van den Akker T. Vacuum extraction for non-rotational and rotational assisted vaginal birth. Best Pract Res Clin Obstet Gynaecol . 2019 Apr;56:47-54

34. Thanks for listening