Vacuum-Assisted Vaginal Delivery at Low Station

Contraindications and Risks

Vacuum-assisted vaginal delivery should not be performed at low station due to the increased risk of significant fetal injury, including intracranial and subgaleal hemorrhage, as recommended by the American College of Obstetricians and Gynecologists 1
The use of vacuum extraction at low station is contraindicated due to potential fetal complications, according to the American College of Obstetricians and Gynecologists 1
Suspected cephalopelvic disproportion is an absolute contraindication for vacuum-assisted vaginal delivery, as stated by the American College of Obstetricians and Gynecologists 3
Vacuum extraction should be avoided in women with maternal coagulation disorders due to increased risk of maternal hemorrhage, as recommended by the American College of Obstetricians and Gynecologists 1
Vacuum should be avoided in cases of maternal hepatitis C with high viral load to reduce vertical transmission risk, according to the American College of Obstetricians and Gynecologists 1

For impacted fetal head during cesarean delivery, the "pull" method (including reverse breech extraction and Patwardhan method) may be safer than vaginal disimpaction techniques, as reported by the American Journal of Obstetrics and Gynecology 5
The Patwardhan method is a modification of reverse breech extraction that requires specialist training, according to the American Journal of Obstetrics and Gynecology 5
Continuous electronic fetal heart rate monitoring is recommended during operative vaginal delivery, as recommended by the American College of Obstetricians and Gynecologists 1
High-fidelity simulation and implementation of standardized care pathways represent the safest and most effective form of training for difficult deliveries, as reported by the American Journal of Obstetrics and Gynecology 2

Proper technique is crucial as errors in performing extractions may increase the risk of fetal fractures and other injuries, as stated by the American College of Obstetricians and Gynecologists 4
Many obstetricians lack adequate training and confidence to perform advanced delivery techniques, according to the American Journal of Obstetrics and Gynecology 5
The lateral decubitus position for the mother can help attenuate hemodynamic impact of uterine contractions during operative delivery, as recommended by the American College of Obstetricians and Gynecologists 3