Dr.kbg

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1/7/04. dr.kbg. 2. . HISTORYIn the Elements of Physics in 1831, Neil Arnott , MD, wrote "The simple contrivance now described, and which may be called a pneumatic tractor, seems well suited to various purposes of surgery." . 1/7/04. dr.kbg. 3. Historical Aspects : Zanzihar fishermen used the s

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3. 1/7/04 dr.kbg 3 Historical Aspects : Zanzihar fishermen used the suction cups of remora (pilot fish) for catching sharks. Hildonus (1632) first applied vacuum principle in surgery when he treated depressed fracture of skull in infants. James young (1708) , mayor of plymouth is credited for the use of a cupping glass to assist delivery.

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5. 1/7/04 dr.kbg 5 Vacuum extraction (VE) has deep historical roots. The origin of vacuum extraction is in ”cupping,” a therapeutic technique used long before Hypocrites. In cupping, a metal or glass cup was heated over an open flame, then applied to a lesion or skin puncture. As the cup cooled, a vacuum developed, extracting blood or other fluids. Cupping also occasionally was used for a number of surgical procedures, such as raising depressed skull fractures.

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7. 1/7/04 dr.kbg 7 The immediate antecedent to modern extractors was the stainless steel cup device, introduced by Malmström in the late 1950s. This device entered US practice late in the 1960s; however, because of technical problems with the original design and case reports of severe fetal complications, interest promptly waned. Within the last several years following the introduction of disposable soft-cup extractors and improved rigid cup designs, VE has experienced a revival. This renewed interest also has led to a more scientific study of vacuum technique, improving both the success and safety of VE.

8. 1/7/04 dr.kbg 8 Synonym : Ventouse Introduction : (Definition) Vacuum is an operation for the delivery of the fetal head from the mother by use of a vacuum extractor applied to the fetal scalp on presence of maternal effort (Hughes)*.

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17. 1/7/04 dr.kbg 17 Forces in vacuum Extraction

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23. 1/7/04 dr.kbg 23 Vacuum Devices

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44. 1/7/04 dr.kbg 44 Bell Vacuum Extractor Cups The Mityvac® Bell cups have a large diameter mouth to distribute tractive force across the fetal scalp. These cups are to be used in the low Occiput Anterior and Outlet presentations.

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49. 1/7/04 dr.kbg 49 Mushroom® Vacuum Extractor Cups The Mityvac® Mushroom® cups are uniquely shaped to provide greater traction and excellent manipulation during vacuum assisted deliveries. These cups can be used in low Occiput Anterior and Outlet presentations or they can be used in low Occiput Posterior (OP) and Occiput Transverse (OT) positions.

50. 1/7/04 dr.kbg 50 The Mityvac® "M" Style™ Mushroom® Vacuum Extractor Cup is uniquely shaped to provide greater traction and excellent manipulation during vacuum assisted deliveries. The cup’s softly contoured design allows for a stronger grip while helping to minimize infant scalp trauma. The flexible stem bends into a 90-degree angle without losing vacuum.

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102. 1/7/04 dr.kbg 102 Mnemonic for Vacuum Extraction A Ask for help, Address the patient, and is Anesthesia needed. B Bladder empty. C Cervix must be completely dilated. D Determine position

103. 1/7/04 dr.kbg 103 E Equipment and Extractor ready. F Apply the cup over the sagittal suture and in relation to the posterior Fontanelle. G Gentle traction in the proper axis.

104. 1/7/04 dr.kbg 104 H Halt traction when the contraction is over; Halt the procedure if you have had disengagement of the cup three times,have had no progress in three consecutive pulls or three "pop- offs.“ I Evaluate for Incision (episiotomy) when the head is being delivered. J Remove the cup after the Jaw is delivered.

105. 1/7/04 dr.kbg 105 Vacuum extraction versus forceps for assisted vaginal delivery (Cochrane Review) Reviewers' conclusions: Use of the vacuum extractor rather than forceps for assisted delivery appears to reduce maternal morbidity. The reduction in cephalhaematoma and retinal hemorrhages seen with forceps may be a compensatory benefit. Johanson RB, Menon V. Vacuum extraction versus forceps for assisted vaginal delivery (Cochran Review). In: The Cochran Library, Issue 2 2003. Oxford: Update Software.

106. 1/7/04 dr.kbg 106 Soft versus rigid vacuum extractor cups for assisted vaginal delivery (Cochran Review) Reviewers' conclusions: Metal cups appear to be more suitable for Occipito-posterior', transverse and difficult Occipito-anterior' position deliveries. The soft cups seem to be appropriate for straightforward deliveries. Citation: Johanson R, Menon V. Soft versus rigid vacuum extractor cups for assisted vaginal delivery (Cochran Review). In: The Cochran Library, Issue 2 2003. Oxford: Update Software

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110. 1/7/04 dr.kbg 110 THANK YOU

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