Vacuum-Assisted Vaginal Delivery

Approximately 5% (1 in 20) of all deliveries in the United States are operative vaginal deliveries. The past 20 years have seen a progressive shift away from the use of forceps in favor of the vacuum extractor as the instrument of choice. This article reviews in detail the indications, contraindications, patient selection criteria, choice of instrument, and technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at the time of cesarean delivery will also be discussed. With vacuum extraction becoming increasingly popular, it is important that obstetric care providers are aware of the maternal and neonatal risks associated with such deliveries and of the options available to effect a safe and expedient delivery.Key words: Operative vaginal delivery, Vacuum-assisted vaginal delivery, VacuumOperative vaginal delivery refers to the application of either forceps or a vacuum device to assist the mother in effecting vaginal delivery of a fetus. The incidence of operative vaginal delivery in the United States is currently estimated at around 5%, or approximately 1 in 20 deliveries,^1–4 although there are large geographic differences in the rates of operative vaginal delivery across the country.² The lowest rates of instrumental vaginal delivery (< 5%) are seen in the Northeast and the highest rates (20%–25%) are in the South.² Although the overall rate of operative vaginal delivery has been declining, the proportion of vacuum-assisted deliveries has been increasing and now accounts for almost 4 times the rate of forceps-assisted vaginal births.²