Contraindications and Precautions for Vacuum-Assisted Vaginal Delivery

Relative Contraindications

• The American Society of Hematology recommends that vacuum-assisted vaginal delivery should be avoided in women with maternal coagulation disorders due to increased risk of maternal hemorrhage 1
• The American College of Obstetricians and Gynecologists suggests that vacuum-assisted vaginal delivery should be avoided in women with afibrinogenemia or severe hypofibrinogenemia due to increased bleeding risk 1
• The Centers for Disease Control and Prevention recommends that invasive procedures, including vacuum extraction, should be avoided in cases of maternal hepatitis C with high viral load to reduce vertical transmission risk 2

Specific Clinical Scenarios Where Vacuum Should Be Avoided

• The American Academy of Pediatrics recommends that vacuum-assisted vaginal delivery should be avoided in women with maternal hepatitis C with high viral load, where invasive procedures should be avoided to reduce vertical transmission risk 2

Vacuum-Assisted Delivery and Risk of Subgaleal Hemorrhage

Clinical Implications

• Continuous electronic fetal heart rate monitoring is recommended during operative vaginal delivery, as stated by the American College of Obstetricians and Gynecologists 3
• The use of a single forceps blade or ventouse as a lever to disimpact the fetal head is considered dangerous and should be avoided, according to the American Journal of Obstetrics and Gynecology 4
• The use of vacuum at cesarean delivery has the potential to cause significant fetal injury, including intracranial and subgaleal hemorrhage, as reported by the American Journal of Obstetrics and Gynecology 4