Vacuum extractors currently in widespread use in the United States are those with a soft cup made of silicone or plastic. They are smaller and more flexible than the classic Malstrom metal cup. Vacuum can be easily applied. Although these cups tend to dislodge somewhat more frequently than the Malstrom metal cup, less scalp trauma is noted with their use. Often, vacuum delivery can be performed with little to no anesthesia. However, requirements of operative vaginal delivery still apply. For the best results, the vacuum cup should be placed over the sagittal suture about 3 cm from the posterior fontanelle. This can be difficult in fetal heads descending with asynclitism (lateral deflection). After placement of the cup, an examining finger is used to ascertain that no cervical, vaginal, or perineal tissue is trapped in the cup. With a contraction, after adequate vacuum is generated, downward and then upward traction should be applied to the fetal head (Fig. 21-20). The fetal head should be allowed to rotate if needed during descent. Forceful rotation of the fetal head using the suction cup is generally not recommended because of the increased risk of scalp injury. Removal of the cup is easily accomplished once suction is
discontinued. The cervix and vagina should be examined carefully for lacerations.
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