Assisted Vaginal Delivery via Vacuum Extraction Practical Session D: Vacuum Extraction Checklist Instructions

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Assisted Vaginal Delivery via Vacuum Extraction

Practical Session D: Vacuum Extraction Checklist
Instructions: Place a “” in the case box if step/task is performed satisfactorily, an “X” if it is not performed satisfactorily, or N/O if not observed.

  • Satisfactory: Performs the step or task according to the standard procedure or guidelines.

  • Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines.

  • Not Observed: Step or task not performed by participant during evaluation by trainer.

Participant: ___________________________________ Date Observed: _______________


(Some of the following steps/tasks should be performed simultaneously.)





  1. Prepare the necessary equipment.

  1. Tell the woman what is going to be done, listen to her, and respond attentively to her questions and concerns.

  1. Provide continual emotional support and reassurance, as feasible.

  1. Review to ensure that the following conditions for vacuum extraction are present:

  • Vertex presentation

  • Fetus at least 34 weeks gestation

  • Cervix fully dilated

  • Head at least at 0 station or no more than 1/5 palpable above the symphysis pubis (for beginners the head should be at 0/5)

  1. Make sure an assistant is available.

  1. Put on an apron and other delivery gear as appropriate.


  1. Wash hands thoroughly with soap and water and dry.

  1. Put sterile surgical gloves on both hands.

  1. Clean the vulva with antiseptic solution and place a drape under the woman’s buttocks and over her abdomen.

  1. Catheterize the bladder, if necessary.

  1. Check all connections on the vacuum extractor and test the vacuum on a gloved hand.


  1. Assess position of the fetal head by feeling the sagittal suture line and fontanelles (both anterior and posterior fontanelle if possible).

  1. Apply the appropriate cup to the flexion point on the fetal head: anterior cup 5 cms up under the fetal head for anterior position, and posterior cup 8-10 cms up under the fetal head for transverse and posterior positions of the fetal head. (The anterior border of the cup must be at least 3 cms back [posterior to] the anterior fontanelle.)

  1. Have the assistant create a vacuum of 0.2 kg/cm2 negative pressure with the pump and check the application of the cup (i.e. there is no maternal soft tissue [cervix or vagina] within the rim of the cup).

  • If necessary, release pressure and reapply the cup.

  1. Increase vacuum to 0.8 kg/cm2 negative pressure and wait 2 minutes for the fetal scalp chignon to form in the cup (i.e. wait for the next contraction) so that the cup will not slip forward on the fetal head when you commence traction.

  1. With the next contraction, start traction downwards (i.e. towards the floor); use the two finger grip to monitor cup lift and fetal head descent (thumb pressing on the cup and forefinger in front of the cup on the fetal scalp). Only pull with contractions.

  • If the fetal head is tilted to one side or not flexed well, downwards traction will correct the tilt or deflexion of the head.

  1. There needs to be progress with each pull. If there is no progress at any time, cease the procedure and consult a senior colleague or refer the mother to a higher-level facility. The fetal head should be delivered in 3-4 pulls; the cup should not be applied to the head of the fetus for more than 25 minutes.

  1. Evaluate the need for an episiotomy, and perform if necessary.

  1. When the head has been delivered, release the vacuum, remove the cup, and complete the delivery including active management of third stage of labor.

  1. Carefully check the birth canal for tears following delivery and repair, if necessary.

  1. Repair the episiotomy, if one was performed.

  1. Provide immediate postpartum and newborn care, including bag and mask resuscitation if the baby is not breathing and crying at 1 minute after birth.

POST-PROCEDURE TASKS (Assess the fetus and check the fetal scalp)

  1. Check that there is no evidence of subgaleal hemorrhage (use the finger flick test to ascertain the severity of a subgaleal hemorrhage).

  1. If there is evidence of a significant subgaleal hemorrhage (i.e. >30-40 mLs), the fetus needs immediate IV or intraosseous normal saline resuscitation. A significant subgaleal hemorrhage can cause shock and death if the baby is not resuscitated adequately with normal saline 1:3 blood loss.

  1. Dispose of instruments in 0.5% chlorine solution for 10 minutes and then thoroughly rinse and dry. Remove gloves by turning them inside out and place them in a leakproof container or plastic bag.

  1. Wash hands thoroughly with soap and water and dry.

  1. Record all information on the woman’s record, including estimated blood loss.

Practical Session D – Observer Checklist

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