Understand The Principles of Vacuum Procedure...M ivery Evidence suggests that vacuum extraction...

ENGLISH

The Fundamentals of Safe Vacuum Delivery 7 HOURS | ONLINE TUTORIAL COURSE

With video tutorials by Aldo Vacca

LESSON TWOUnderstand The Principles of Vacuum Procedure

CLASS WORKBOOK

YOUR NAME _________________________________________

YOUR EMAIL _________________________________________

Official Academy Education

18 | THE FUNDAMENTALS OF SAFE VACUUM DELIVERY © VACCA ACADEMY .com

NOTES

LESSON TWO

LESSON OUTLINE

LEARN THE FUNDAMENTALS OF A VACUUM ASSISTED DELIVERY PROCEDURE. UNDERSTAND AND BECOME FAMILIAR WITH THE TECHNICAL PRINCIPLES OF VACUUM DELIVERY.

CONCEPTS • First-line method for assisted birth • Fundamental principles • The flexion point • The midline

• Position & diameters of the head • Flexion of the head • Ideal cup placement • Digital

distance • The midpoint of the head • Axis of the pelvis (axis traction) At the workshop, you

will be preparing for Level C (beginner grade) entry into your organisation’s official training

program for safe vacuum-assisted delivery.

Master the art of safe vacuum delivery

Evidence suggests that vacuum extraction causes less discomfort during and after delivery but is associated with greater anxiety for the mother at the appearance of the cup marking and chignon on the scalp. Vacuum extraction can be performed using simpler forms of analgesia.

LESSON TWO

READING


LESSON TWO

VACUUM DELIVERY AS THE FIRST -LINE METHOD FOR ASSISTED BIRTHThe Cochrane Review, Choice of instruments for assisted vaginal delivery (2010) supports the

use of vacuum extraction as the first-line method for assisted birth. Vacuum-assisted births

are becoming the mode of choice to expedite birth compared to forceps, due to ease of

application and low incidence of maternal trauma (Clinical Excellence Commission 2014). At

the workshop, you will be preparing for Level C (beginner grade) entry into your organisation’s

official training program for safe vacuum-assisted delivery.

THE THREE FUNDAMENTALSIn simple terms, the three fundamental elements of a vacuum delivery procedure may be

considered as (a) the mother’s expulsive efforts, (b) the operator performing a flexion correction

of the head, and (c) assisting the remainder of the birth with gentle traction.

C B A


LESSON TWO

The aim of vacuum-assisted delivery is to replicate the normal mechanism of labour and not to overcome resistance to descent with excessive traction.

VACUUM DELIVERY SHOULD REPLICATE THE MECHANISM OF LABOURA well-flexed, synclitic fetal head will progress through the birth canal with minimal resistance,

provided the propulsive forces are effective and there is no cephalopelvic disproportion (CPD).

Therefore, if the head is found to be deflexed or asynclitic the operator should know how to

correct the attitude of the head with the vacuum extractor to one of flexion and synclitism.

Most fetal heads enter the pelvic brim in a non-OA position yet undergo spontaneous internal

rotation to OA in nearly all cases. The aim of Vacuum-Assisted Delivery (VAD) is to replicate this

normal process of labour and not to overcome resistance to descent with excessive traction.

ESSENTIAL PRINCIPLES FOR VACUUM-ASSISTED DELIVERYThe flexion point is located on the sagittal suture, 3cm from the posterior fontanelle. It marks

the spot where the mento-vertical diameter emerges on the vertex. When the flexion point

is the presenting part, the optimal head diameters are presenting. Therefore, to achieve the

best presenting diameters during vacuum delivery, the cup should be placed over the flexion

point. However, since the mento-vertical diameter is approximately 213cm in length, the head

pivots around an axis at the level of the midpoint, about 6cm from the flexion point. Downward

traction encourages the midpoint to descend along the axis of the pelvis.

* ALL USERS OF THE VACUUM EXTRACTOR SHOULD BECOME CONFIDENT AT LOCATING THE FLEXION POINT AND CALCULATING THE DISTANCE FROM THE FLEXION POINT TO THE VAGINAL FOURCHETTE SINCE THIS IS THE DISTANCE THAT THE VACUUM CUP MUST BE INSERTED TO ACHIEVE A FLEXING APPLICATION.


LESSON TWO

The flexion point is a critical landmark for vacuum extraction; when the flexion point is aligned with the axis of the pelvis the optimal diameters of the fetal head will be presenting for delivery.

THE FLEXION POINTSince the flexion point is located on the fetal head anterior to the posterior fontanelle, it

will move through a much smaller arc in the birth canal than that of the posterior fontanelle

and therefore will be situated closer to the midline of the mother’s birth canal irrespective of

position and attitude of the head. However, station, position and attitude will alter the distance

of the flexion point from the introitus. For practical purposes, therefore, the vacuum cup should

be inserted the calculated insertion distance along the midline axis of the maternal pelvis

without the need for significant lateral movement.

LESSON ONE


CORRECT CUP APPLICATION

FLEXING MEDIAN

INCORRECT CUP APPLICATION

FLEXING PARAMEDIAN DEFLEXING MEDIAN DEFLEXING PARA MEDIAN

CORRECT PLACEMENT OF THE VACUUM CUPA flexing median application is an important prerequisite for successful vacuum extraction.

Deflexing and paramedian applications promote or fail to correct extension and asyncliticism

of the head and effectively increase or fail to decrease the diameters and size of the area of the

presenting part.

FLEXING MEDIAN APPLICATION - FLEXION OF THE HEADIdeal application of the vacuum cup is achieved when the centre of the cup is superimposed on

the flexion point and the cup is symmetrically placed over the sagittal suture. This application is

described as flexing median.


WATCH THE LESSON VIDEO AND FOLLOW ALONG WITH THIS WORKBOOK.

WHEN YOU SEE THIS ICON, PAUSE THE VIDEO.Draw and label each diagram.

GO TO

WWW.VACCAACADEMY.COM

LESSON TWO

VIDEO


LESSON TWO

NOTES

NOTES


LESSON TWO

NOTES


LESSON TWO

ACTIVITIESUNDERSTAND THE PRINCIPLES

OF VACUUM PROCEDURE


LESSON TWO

* SUCCESS OF VACUUM EXTRACTION DEPENDS LARGLEY ON THE CLINICIAN PERFORMING THE PROCEDURE (THE OPERATOR), WHO IS USUALLY A DOCTOR BUT IN SOME CASES MAY BE A MIDWIFE. TRAINING IN VACUUM DELIVERY INCLUDES TEACHING THE OPERATOR HOW TO USE THE INSTRUMENT APPROPRIATELY AND CORRECTLY AND HOW TO SELECT PATIENTS FOR WHOM VACUUM DELIVERY WILL BE SAFE AND SUCCESSFUL.

ACTIVITY ONE

WHY IS VACUUM DELIVERY CONSIDERED THE FIRST-LINE METHOD FOR ASSISTED BIRTH? * Cochrane Review, Choice of instruments for assisted vaginal delivery (2010)

NOTES


LESSON TWO

* THE MOTHER’S PARTICIPATION IN VACUUM ASSISTED DELIVERY IS CRUCIAL FOR THE SUCCESS OF THE PROCEDURE AND, IN ADDITION, HAS A NUMBER OF ADVANTAGES. NOT ONLY WILL THE MOTHER DERIVE SATISFACTION FROM KNOWING THAT DELIVERY OCCURRED LARGELY AS A RESULT OF HER OWN EFFORTS BUT THE BABY, TOO, WILL BENEFIT BECAUSE THE GREATER THE MOTHER’S CONTRIBUTION TOWARDS THE BIRTH THE LESS WILL BE THE AMOUNT OF TRACTION NECESSARY WITH THE VACUUM EXTRACTOR TO ACHIEVE DELIVERY.

ACTIVITY TWO

Pull only during a uterine contraction and while the mother is pushing. Do not pull if the mother is not pushing!

WHAT IS VACUUM DELIVERY? EXPLAIN THE AIMS OF THE PROCEDURE.

NOTES


LESSON TWO

ACTIVITY THREE

STUDY THE IMAGE AND LABEL THE FLEXION POINT.

EXPLAIN THE IMPORTANCE OF THE FLEXION POINT IN CLINICAL PRACTICE.

NOTES


LESSON TWO

* DETACHMENT OF THE CUP MAY OCCUR IF UPWARD TRACTION IS APPLIED BEFORE THE MIDPOINT OF THE HEAD HAS PASSED BENEATH THE PUBIC ARCH.

ACTIVITY FOUR

DESCRIBE THE MIDPOINT OF THE HEAD AND EXPLAIN ITS IMPLICATIONS FOR CLINICAL PRACTICE.

NOTES


LESSON TWO

* THE DISPLACEMENT OF THE FLEXION POINT FROM THE MIDLINE AXIS OF THE MATERNAL PELVIS IN OP AND OT POSITIONS IS MUCH LESS THAN ONE WOULD EXPECT. FOR PRACTICAL PURPOSES, IN THESE POSITIONS OF THE HEAD, THE FLEXION POINT WILL BE SITUATED IN THE SACRAL SPACE ON OR NEAR THE MIDLINE OF THE PELVIS. THIS FACT HAS IMPORTANT IMPLICATIONS FOR CORRECT VACUUM CUP APPLICATION.

ACTIVITY FIVE

The flexion point remains near the midline of the maternal pelvic axis in all positions of the fetal head.

STUDY THE IMAGE AND LABEL THE FLEXION POINT AND POSTERIOR FONTANELLE.

EXPLAIN THE MIDLINE AND ITS IMPLICATION FOR CLINICAL PRACTICE.

NOTES


LESSON TWO

EXPLAIN HOW OPTIMAL PRESENTATION IS ACHIEVED IN A VACUUM PROCEDURE.

NOTES

ACTIVITY SIX

STUDY THE IMAGE AND LABEL THE FONTANELLES AND FLEXION POINT. CIRCLE THE POSITION WITH THE OPTIMAL PRESENTATION FOR BIRTH.

Deflexion

and synclitism

Flexion

and asynclitism

Deflexion

and asynclitism

Flexion

and synclitism


LESSON TWO

ACTIVITY SEVEN

If position of the head is still in doubt, vacuum extraction should not be attempted unless the head has descended to the outlet of the pelvis and caput is visible at the introitus between contractions.

Since localisation of the flexion point on the fetal scalp and, therefore, correct application of the

vacuum cup depend on knowledge of the position of the head, every effort should be made to

establish the position as accurately as possible before vacuum delivery is attempted.

STUDY THE IMAGE, LABEL THE FONTANELLES AND LOCATION OF THE FLEXION POINT.

NOTES

Occipitoposterior (OP)

position

Occipitotransverse (OT)

position

Direct occipitoanterior (OA)

position


LESSON TWO

* TO KEEP THE MIDPOINT OF THE HEAD ALIGNED WITH THE AXIS OF THE PELVIS, THE FLEXION POINT SHOULD DESCEND BEHIND THE PELVIC AXIS.

ACTIVITY EIGHT

Never pull upwards until the midpoint has passed under the pubic arch.

DRAW A DIAGRAM OF THE FETAL HEAD AS IT PASSES UNDER THE SUB-PUBIC ARCH. LABEL YOUR DIAGRAM WITH THE FLEXION POINT, THE MIDPOINT, THE SUB-PUBIC ARCH, AND PELVIC AXIS.

NOTES

ASSESSOR’S COMMENTS


Complete Lesson TWO with the online revision quiz

WWW.VACCAACADEMY.COM

LESSON TWO IS ALMOST COMPLETE.

LESSON TWO

QUIZ REVISION

Understand The Principles of Vacuum Procedure...M ivery Evidence suggests that vacuum extraction...

Documents

Transcript of Understand The Principles of Vacuum Procedure...M ivery Evidence suggests that vacuum extraction...