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Fetal Skull Fractures from Vacuum Extraction Devices

Wednesday, 29 October 2008 10:02

The vacuum extractor is being increasingly advocated as the instrument of first choice for assisted vaginal delivery. It is widely believed that the vacuum cup will dislodge before causing serious fetal trauma. The vacuum extractor exerts considerable traction force. Fetal skull fracture can result, and its true incidence may be higher than expected, considering that few neonates with normal neurologic behavior undergo skull x-ray.

Skull fracture caused by vacuum extraction   Hickey K, McKenna P.   Obstet Gynecol 1996 Oct;88(4 Pt 2):671-6

In only 134 vacuum extraction-assisted deliveries there were 28 infants with scalp trauma, including 17 superficial lacerations, six large caputs, and 12 cephalohematomata; one infant had subgaleal, subdural, and subarachnoid hemorrhages. The proportion of injuries was greater for applications exceeding 10 minutes (6 of 9) than for those 10 minutes or shorter (22 of 121, P < .01). Cosmetic scalp trauma occurred in 21% of our newborns delivered by vacuum extraction and was more common after longer vacuum applications, longer second stages, and paramedian cup placement.

Vacuum extraction: does duration predict scalp injury?   Teng FY, Sayre JW. Obstet Gynecol 1997 Feb;89(2):281-5