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VACUUM USE WITH VERNIX, BLOOD, AND FLUID
The issue of vernix, blood, or
amniotic fluid causing vacuum cup malfunction or detachment has been a cause of concern for
many vacuum users. It is possible for liquid to pool in the space
between the sacral cavity and the fetal head, so that during the initial
formation of the vacuum, some fluid may be sucked into the cup and pump
mechanism. However, provided the pressure is not reduced once
established, the cup should remain attached to the scalp which should limit the
amount of blood/fluid that could possibly get introduced into the
system.
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Dr. Vacca reported that it is conceivable, although extremely
rare, a plug of vernix may interfere with suction initially, but this would
occur at the time of inducing the negative pressure and not during the pulling
stages of the procedure.
To avoid this perceived problem of too much
amniotic fluid, blood, and vernix, do not reduce the vacuum or move the
cup location once it has been placed over the flexion point (3 cm forward
of posterior fontanelle), as this
subjects the system to leaks and may pull liquid into the cup.
Bofill (Obstet & Gynecol, 1997: 89: 758-762) and the ACOG guidelines
(No. 17, June 2000) state that vacuum reduction between contractions has
not been shown to change maternal or neonatal outcomes, thus is not
necessary.
Finally, in the experienced words of Dr.
Vacca, "while I will concede that there may be a very rare occasion
when the above mentioned factors contribute to cup slippage, I believe in
the vast majority of cases it is likely to be an error of technique as the
basis of the problem." Thus, proper cup placement and traction
will help physicians avoid this apparent problem.
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Pull in line with Pelvic Axis
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Place Center of Cup over
Flexion Point
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The OmniCup has been shown to work under water. 30 cc of fluid
placed directly into the cup does not interfere with the OmniCup vacuum
function. Furthermore, if one pumps the PalmPump® several
times in air, so as to "clear the system," the vacuum will
function perfectly, even fully submerged. It is hard to believe that
there would be more liquid trapped under or within the cup during a
delivery than this situation with the cup fully submerged under
water.
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This Month's Winners
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| Maj. Joanne Altringer, Jesup, GA |
| Rondi Anderson, Salem, MA |
| Stephen Kasparsian, Fall River, MA |
Prize: Handbook of Vacuum
Extraction by Aldo Vacca
Please contact Clinical Innovations at insights@clinicalinnovations.com
to claim your prize.
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