🔘 Ventous Delivery

VENTOUS DELIVERY:-

👉🏻 Definition:-

- Ventouse is an instrumental device designed to assist delivery by creating a vacuum between it and foetal scalp.

- The pulling force is dragging the cranium in forceps while in Ventouse, the pulling force is directly transmitted to the base of the skull.

👉🏻 Instrumentation Components:-

- A suction cup with four sizes (30mm, 40mm 50mm, 60mm)

- Metal cup

- Soft cup

- Elastic cup

- Rigid plastic cup

- Vacuum pump

- Traction tubing

👉🏻 Indications:-

1. Maternal indications:-

- Maternal distress, exhaustion after a long, painful labour, due to inefficient uterine contractions.

- Prolonged second stage of labour.

- (Nulliparous: >3hrs with regional analgesia >2hrs without regional analgesia Parous: >2hrs with regional analgesia >1 hr without regional analgesia).

- Maternal medical disorders such as heart disease, hypertensive disorders and moderate to severe anaemia.

- Previous caesarean section or genital prolapse repair.

- Intra partum infection, certain neurological conditions.

2. Foetal indications:-

- Prolapse of umbilical cord

- Premature separation of placenta

- Non reassuring foetal heart rate pattern

- Foetal distress

- Non rotated heads or occipito-transverse positions

- The Occipito posterior position

👉🏻 Contraindications:-

- Operator inexperience

- Inability to assess foetal position

- Suspicion of CPD

- Foetal coagulopathy Preterm babies due to risk of foetal intraventricular haemorrhage

- Macrosomia (≥4 kg)

- Soft tissues obstruction in the pelvis

- Breech presentation and face presentation.

👉🏻 Procedure:-

1. Preoperative:-

- The woman's bladder should be empty.

- The patient is placed in the lithotomy position.

- Vaginal examination to check pelvic capacity, cervical dilatation, presentation, position, station and degree of flexion of head and that the membranes are ruptured.

- Determination of flexion point

- Informed consent with prior clear explanation

- Pudendal block or perineal infiltration with 1% lignocaine, in parous women applied even without anaesthesia.

+ The instrument should be assemble and the vacuum is tested prior to its application.

2. Operative:-

Step-1: Application of the cup:-

- The largest possible cup according to the dilatation of the cervix is to be selected.

- The cup is introduced after retraction of the perineum with two fingers of the other hand.

- The cup is placed against the foetal head nearer to the occiput (flexion point) with the knob of the cup pointing towards the occiput.

- Betadine solution is applied to the rim of the metal cup.

- A check is made using the fingers round the cup to ensure that no cervical or vaginal tissue is trapped inside the cup.

- The pressure is gradually raised at the rate of 0.1kg/cm² per minute until the effective vacuum of 0.8kg/cm² is achieved in about 10 minutes time

- The scalp is sucked into the cup and an artificial caput succedaneum is produced, which disappears within few hours.

- Instrument handle is grasped, and initiation of traction.

Step-2: Traction:-

- Traction is initiated by using a two-handed technique, i.e the fingers of one hand are placed against the suction cup, while the other hand grasps the handle of the instrument.

- Traction must be at right angle to the cup

- Traction directed initially downward then progressively extended upward as head emergy

- Traction should be synchronous with the uterine contractions; released in 

between the contractions.

- Once head is extracted, vacuum pressure is relieved; cup is removed; vaginal delivery followed.

👉🏻 Time:-

- The total time from the application until delivery should not exceed 20 minutes.

- If >20 minutes, the risk of foetal scalp trauma and intracranial damage increases.

- Many pulls to achieve progress should not be done

- The operator should be willing to abandon the procedure if it does not proceed easily or if the cup dislodges >3 times

👉🏻 Complications:-

1. Foetal:-

- Scalp laceration and bruising

- Sloughing of the scalp

- Cephalohematoma

- Intracranial haemorrhage - Interventricular and cerebral haemorrhages

- Retinal and sub-conjunctival haemorrhages

- Neonatal jaundice

- Hypoxia

- Foetal death

2. Maternal:-

- Soft tissues injuries such as cervical tears, annular detachment of the cervix, vaginal tears, perineal lacerations and tears, extension of episiotomy, vaginal wall and perineal hematomas.

- Traumatic postpartum haemorrhages

- Infection

- Genital prolapse.