3
Contraindications
1) Arrest of descent where fetopelvic relationships are considered to be inadequate,
2) Unengaged presenting part, 3) All non-vertex presentations 4) Non-ruptured
membranes, 5) Incomplete cervical dilation and effacement, 6) Extreme
prematurity, 7) Known fetal coagulopathies.
Precautions
ACOG Technical Bulletin #154 Nov. 2015: “As with forceps procedures, there should
be a willingness to abandon attempts at vacuum delivery if satisfactory progress is
not made.”
Additional conditions for close observations:
1) Gestational age less than 37 weeks or estimated fetal weight (EFW) less than
2500 grams, 2) Previous scalp sampling, 3) Scalp damage, 4) Failure
of efforts during prolonged period after properly assessed placement,
5) Delivery requiring unusual amounts of traction, 6) Suspected macrosomia.
Adverse Events
Fetal Injuries: cephalhematoma, subdural, subgaleal, intraventricular, or
parenchymal hematoma, subconjunctival, intracranial, or retinal hemorrhage, nerve
injuries, subjective jaundice, elevated bilirubin, bruises, contusions, lacerations,
fractures.
Maternal Injuries: Soft tissue injuries, episiotomy extensions.
Warnings
Limit use to trained, experienced, or supervised operators. Insertion should
be performed carefully, using aseptic technique. Forced insertion may result in
malfunction, patient discomfort, or patient/fetal trauma.
Never apply cup to any portion of infant’s face or exceed recommended
vacuum level, time limits, or cup “pop-off” applications.
